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Sample records for underwent emergency surgery

  1. Megarectumsigma underwent surgery for chronic faecal impact action

    International Nuclear Information System (INIS)

    Canessa, C.; Gomez del Valle, M.; Caraballo, M.

    2002-01-01

    Seven patients with megarectumsigma underwent surgery for chronic faecal impaction,reviewing clinical diagnosis, aetiology and medical and surgical management.It is suggested medical management of chronic faecal impaction trying to achieve elective surgery.The curative surgery should include the resection of all pathologic bowel, but in Duhamel procedure and its modifications distal rectal tran section should be at the peritoneal reflection.Habr-Gama modification has shown to be technically easier and it has been communicated good functional results.Local unfavourable conditions may be resolve by staged surgery,which allows outline definitive bowel reconstruction after functional assessment

  2. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  3. Posterior Reversible Encephalopathy Syndrome in Patients who Underwent Cardiovascular Surgery

    International Nuclear Information System (INIS)

    Granados, Ana Maria; Bueno Melo, Juliana; Acosta Puentes, Diana

    2012-01-01

    The etiology of posterior reversible encephalopathy syndrome (pres) is not well understood. This entity has been reported in relation to multiple clinical conditions. It has been proposed that the vertebrobasilar circulation is more sensitive to injuries sustained by the central nervous system. Consequently, the main radiologic manifestations of this condition occur in the pareto-occipital regions. As its name implies, pres has a reversible nature. Once the noxious factors are withdrawn, both the vasogenic edema in affected areas, as well as neurological symptoms tends to resolve, whereas if the situation persists the lesions may progress to parenchymal ischemia. Cerebral computed tomography (CT) in pres may show hypodense areas in the affected white matter. Magnetic resonance (MR) imaging is used to better characterize the abnormal regions. This modality is capable of displaying an increased signal intensity in these areas on T2-weighted FLAIR sequences that is less apparent on diffusion-weighted images. In order to confirm this diagnosis, a follow up imaging study either with CT or MR can be performed approximately four weeks after the onset of symptoms. Nevertheless, an exact consensus with respect to the follow-up period has not been reached. The supporting findings for this diagnosis include resolution of the affected white matter and clinical remission without neurological sequelae. We hereby report three proven cases of pres in patients of different age groups that had undergone major cardiovascular surgery with extracorporeal circulation, a common factor that was thought to have been the precursor to this condition in these individuals.

  4. Emergency surgery for Crohn's disease.

    Science.gov (United States)

    Smida, Malek; Miloudi, Nizar; Hefaiedh, Rania; Zaibi, Rabaa

    2016-03-01

    Surgery has played an essential role in the treatment of Crohn's disease. Emergency can reveal previously unknown complications whose treatment affects prognosis. Indicate the incidence of indications in emergent surgery for Crohn's disease. Specify the types of procedures performed in these cases and assess the Results of emergency surgery for Crohn's disease postoperatively,  in short , medium and long term. Retrospective analysis of collected data of 38 patients, who underwent surgical resection for Crohn's disease during a period of 19 years from 1992 to 2011 at the department of surgery in MONGI SLIM Hospital, and among them 17 patients underwent emergency surgery for Crohn's disease. In addition to socio-demographic characteristics and clinical presentations of our study population, we evaluated the indications, the type of intervention, duration of evolution preoperative and postoperative complications and overall prognosis of the disease. Of the 38 patients with Crohn's disease requiring surgical intervention, 17/38 patients underwent emergency surgery. Crohn's disease was inaugurated by the complications requiring emergency surgery in 11 patients. The mean duration of symptoms prior to surgery was 1.5 year. The most common indication for emergency surgery was acute intestinal obstruction (n=6) followed by perforation and peritonitis (n=5). A misdiagnosis of appendicitis was found in 4 patients and a complicated severe acute colitis for undiagnosed Crohn's disease was found in 2 cases. The open conventional surgery was performed for 15 patients. Ileocolic resection was the most used intervention. There was one perioperative mortality and 5 postoperative morbidities. The mean of postoperative hospital stay was 14 days (range 4-60 days). Six patients required a second operation during the follow-up period. The incidence of emergency surgery for Crohn's disease in our experience was high (17/38 patients), and is not as rare as the published estimates

  5. Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

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    Valérie Huynh-Trudeau

    2015-01-01

    Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

  6. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

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    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  7. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

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    Alessandro Varrica

    2015-01-01

    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

  8. Dysphagia among adult patients who underwent surgery for esophageal atresia at birth.

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    Huynh Trudeau, Valérie; Maynard, Stéphanie; Terzic, Tatjana; Soucy, Geneviève; Bouin, Mickeal

    2015-03-01

    Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and⁄or anatomical anomalies. To determine the motor and anatomical causes of dysphagia. A total of 41 adults, followed at the Esophageal Atresia Clinic at Hôpital Saint-Luc (Montreal, Quebec), were approached to particpate in the present prospective study. Evaluation was completed using upper endoscopy, manometry and barium swallow for the participants who consented. The medical charts of respondents were systematically reviewed from the neonatal period to 18 years of age to assess medical and surgical history. All 41 patients followed at the clinic consented and were included in the study. Dysphagia was present in 73% of patients. Esophagogastroduodenoscopy was performed in 32 patients: hiatal hernia was present in 62% (n=20); esophageal diverticulum in 13% (n=4); macroscopic Barrett esophagus in 31% (n=10); and esophagitis in 19% (n=6). Histological esophagitis was present in 20% and intestinal metaplasia in 10%. There were no cases of dysplagia or adenocarcinoma. Esophageal manometry was performed on 56% of the patients (n=23). Manometry revealed hypomotility in 100% of patients and included an insufficient number of peristaltic waves in 96%, nonpropagating peristalsis in 78% and low-wave amplitude in 95%. Complete aperistalsis was present in 78%. The lower esophageal sphincter was abnormal in 12 (52%) patients, with incomplete relaxation the most common anomaly. Of the 41 patients, 29 (71%) consented to a barium swallow, which was abnormal in 13 (45%). The anomalies found were short esophageal dilation in 28%, delay in esophageal emptying in 14%, diverticula in 14% and stenosis in 7

  9. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery.

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    Shantavasinkul, Prapimporn Chattranukulchai; Omotosho, Philip; Corsino, Leonor; Portenier, Dana; Torquati, Alfonso

    2016-11-01

    Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. An academic medical center in the United States. A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (Pweight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (Pweight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  10. Outcome of Patients Underwent Emergency Department Thoracotomy and Its Predictive Factors

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    Shahram Paydar

    2014-08-01

    Full Text Available Introduction: Emergency department thoracotomy (EDT may serve as the last survival chance for patients who arrive at hospital in extremis. It is considered as an effective tool for improvement of traumatic patients’ outcome. The present study was done with the goal of assessing the outcome of patients who underwent EDT and its predictive factors. Methods: In the present study, medical charts of 50 retrospective and 8 prospective cases underwent emergency department thoracotomy (EDT were reviewed during November 2011 to June 2013. Comparisons between survived and died patients were performed by Mann-Whitney U test and the predictive factors of EDT outcome were measured using multivariate logistic regression analysis. P < 0.05 considered statistically significant. Results: Fifty eight cases of EDT were enrolled (86.2% male. The mean age of patients was 43.27±19.85 years with the range of 18-85. The mean time duration of CPR was recorded as 37.12±12.49 minutes. Eleven cases (19% were alive to be transported to OR (defined as ED survived. The mean time of survival in ED survived patients was 223.5±450.8 hours. More than 24 hours survival rate (late survived was 6.9% (4 cases. Only one case (1.7% survived to discharge from hospital (mortality rate=98.3%. There were only a significant relation between ED survival and SBP, GCS, CPR duration, and chest trauma (p=0.04. The results demonstrated that initial SBP lower than 80 mmHg (OR=1.03, 95% CI: 1.001-1.05, p=0.04 and presence of chest trauma (OR=2.6, 95% CI: 1.75-3.16, p=0.02 were independent predictive factors of EDT mortality. Conclusion: The findings of the present study showed that the survival rate of trauma patients underwent EDT was 1.7%. In addition, it was defined that falling systolic blood pressure below 80 mmHg and blunt trauma of chest are independent factors that along with poor outcome.

  11. [Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

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    Saito, Hajime; Minamiya, Yoshihiro

    2016-01-01

    Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

  12. [Findings from Total Colonoscopy in Obstructive Colorectal Cancer Patients Who Underwent Stent Placement as a Bridge to Surgery(BTS)].

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    Maruo, Hirotoshi; Tsuyuki, Hajime; Kojima, Tadahiro; Koreyasu, Ryohei; Nakamura, Koichi; Higashi, Yukihiro; Shoji, Tsuyoshi; Yamazaki, Masanori; Nishiyama, Raisuke; Ito, Tatsuhiro; Koike, Kota; Ikeda, Takashi; Takayanagi, Yasuhiro; Kubota, Hiroyuki

    2017-11-01

    We clinically investigated 34 patients with obstructive colorectal cancer who underwent placement of a colonic stent as a bridge to surgery(BTS), focusing on endoscopic findings after stent placement.Twenty -nine patients(85.3%)underwent colonoscopy after stent placement, and the entire large intestine could be observed in 28(96.6%).Coexisting lesions were observed in 22(78.6%)of these 28 patients.The lesions comprised adenomatous polyps in 17 patients(60.7%), synchronous colon cancers in 5 patients(17.9%), and obstructive colitis in 3 patients(10.7%), with some overlapping cases.All patients with multiple cancers underwent one-stage surgery, and all lesions were excised at the same time.Colonoscopy after colonic stent placement is important for preoperative diagnosis of coexisting lesions and planning the extent of resection. These considerations support the utility of colonic stenting for BTS.

  13. The Demographics of Patients with Skin Cancer who Underwent Surgery in Diyarbakır and Performed Surgical Techniques

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    Burhan Özalp

    2018-06-01

    Full Text Available Objective: The major factor for developing malignant skin cancers is sunlight exposure. This study aimed to evaluate the demographics of patients with skin cancers who underwent surgery in Diyarbakır where the population is exposed to more sunlight than most other Turkish cities. Methods: The medical records of patients who underwent surgery for malignant skin cancer excision between 2011 and 2016 were searched using University Hospital’s patient database program. Data about patients’ demographics, cancer features, and the surgical techniques performed were collected. Results: Over a 5-year period, 190 patients underwent surgical excision. The male to female ratio was 1.56, and the mean age was 65.8 ± 15.7 (range, 20-94 years. The most common skin cancer was basal cell carcinoma (n=138, 72.7%, followed by squamous cell carcinoma (n=45, 23.7% and malignant melanoma (n=5, 2.6%. The most common surgery was primary excision, which was performed in 90 of 190 patients (47.36%; tissue reconstruction with a skin graft or flap surgery was required for the remaining 100 (52.63%, showing a significant difference (p<0.001. Conclusion: Basal cell carcinoma is the most common skin cancer, and less than half of the patients sought treatment immediately after they recognized the lesion. The public should be educated about skin cancers to increase early diagnosis and encourage timely treatment, thereby decreasing morbidity and mortality from skin cancer.

  14. Emerging technologies in surgery

    International Nuclear Information System (INIS)

    Satava, R.M.; Gaspari, A.; Di Lorenzo, N.

    2007-01-01

    Tremendous acceleration and changes in scientific discovery and progress are presently occurring. These important emerging technologies that will affect the practicing surgeon within the next 10 to 20 years are illustrated in detail in this volume. Its purpose is not to review clinical experience of the common surgical practice of the past decade, but to outline and illustrate the future trends. International experts in this field demonstrate emerging procedures and significant advances. (orig.)

  15. The Effectiveness of Adjuvant Hyperbaric Oxygen Therapy in Adults who Underwent Hypospadias Surgery

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    Onder Kara

    2017-01-01

    Full Text Available Aim: To evaluate the role of hyperbaric oxygen therapy (HBO2T with buccal mucosal tube urethroplasty in adult patients with hypospadias. Material and Method: Sixteen adult patients with hypospadias were included in our study. Patients with a short urethra and penile curvature were treated in two stages (orthoplasty buccal mucosal tube urethroplasty. Buccal mucosa was taken and prepared for tube urethroplasty around a 16 French (Fr nelaton catheter and the urethral tube was introduced between the urethral meatus and glans penis. Beginning the 1st postoperative day (HBO2T was applied for 10 sessions during weekdays in 13 patients. Results: The mean age was 21 (±1.23 years and mean follow-up time was 10.1 (±2.1 months. In the group who received HBO2T postoperatively (n=13, a two-stage (orthoplasty buccal mucosal tube urethroplasty procedure was performed in 6 (46%, and the mean length of graft was 5.4 (±1.23 cm. In this group of 13 the success rate without any additional manipulations (urethrotomy intern, fistula repair was 54% (7/13. After additional manipulations, complete healing was achieved in 11 out of 13 patients (84.6%. In the group who did not receive HBO2T postoperatively (n=3, a two-stage procedure was performed in 1 patient (33%, and the mean length of graft was 8 (±5 cm. In this group of 3, complete healing was not achieved in any of these patients as a result of the hypospadias surgery. However, after the additional manipulations, complete healing was achieved in 1 patient (33%. Discussion: Given the promising rates of surgical success, postoperative HBO2T might be considered as a supportive treatment modality for adult patients with hypospadias who undergo buccal mucosal tube urethroplasty. Randomized controlled studies are needed.

  16. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability

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    Lirong Zhang

    2018-01-01

    Full Text Available Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS. Three main components (naringin, naringenin, and hesperetin were isolated from C. aurantium. Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n=47 and control group (CG, received 20 mg placebo daily, n=48. After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group (P>0.01. The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

  17. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability.

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    Zhang, Lirong; Xu, Xiaohua; Jiang, Tiechao; Wu, Kunzhe; Ding, Chuanbo; Liu, Zhen; Zhang, Xuanhe; Yu, Tianhua; Song, Changlong

    2018-01-01

    Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS). Three main components (naringin, naringenin, and hesperetin) were isolated from C. aurantium . Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n = 47) and control group (CG, received 20 mg placebo daily, n = 48). After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group ( P > 0.01). The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

  18. The effects of transfusion of irradiated blood upon cellular immune response in patients underwent open heart surgery

    International Nuclear Information System (INIS)

    Togashi, Ken-ichi; Nakazawa, Satoshi; Moro, Hisanaga; Yazawa, Masatomo; Kanazawa, Hiroshi; Hayashi, Jun-ichi; Yamazaki, Yoshihiko; Eguchi, Shoji

    1989-01-01

    The purpose of this paper is to demonstrate the effect of the transfusion of blood received 1500 rad exposure upon the immune response in 14 patients underwent various type of cardiac surgery. 13 patients received known amounts banked blood and irradiated fresh blood, while one patient received a lot of amounts of banked and irradiated and non-irradiated fresh blood. The authors studied the numbers of lymphocytes as well as lymphocyte subsets such as pan-T cells, B cells, helper/inducer T cells (T H/I ), cytotoxic/supressor T cells (T C/S ), active T cells, natural killer (NK) cells and NK cell activity during two weeks after surgeries. In all 14 patients, pan-T lymphocytes decreased markedly in a few days after surgeries, but increased to higher levels on the eight postoperative day than the levels preoperatively. T H/I and T C/S lymphocytes changed on the similar pattern as pan-T lymphocytes. Active T and B cells did not change significantly in two weeks. The number and activity of NK cells gave the lowest levels on the second postoperative day and did not recovery to the preoperative levels in two weeks. One patient received non-irradiated fresh blood showed the similar immune response as other 13 patients, while he gave the lower levels than others did. This patient died of graft-versus-host disease (GVHD)-like syndrome on the 36th postoperative day. It may be thought that the transfusion of irradiated blood would prevent the host from GVHD and gave the better effects on the immune response than that of non-irradiated blood following open-heart surgeries. (author)

  19. Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery

    OpenAIRE

    Maimaituxun, Gulinu; Shimabukuro, Michio; Salim, Hotimah Masdan; Tabata, Minoru; Yuji, Daisuke; Morimoto, Yoshihisa; Akasaka, Takeshi; Matsuura, Tomomi; Yagi, Shusuke; Fukuda, Daiju; Yamada, Hirotsugu; Soeki, Takeshi; Sugimoto, Takaki; Tanaka, Masashi; Takanashi, Shuichiro

    2017-01-01

    Background Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Methods Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery ...

  20. Vaginal carcinoma in a young woman who underwent fertility-sparing treatment involving chemotherapy and conservative surgery.

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    Mabuchi, Yasushi; Yahata, Tamaki; Kobayashi, Aya; Tanizaki, Yuko; Minami, Sawako; Ino, Kazuhiko

    2015-06-01

    Vaginal carcinoma is a rare gynecological malignancy that is usually treated by radiation therapy and/or surgery combined with chemotherapy. Here, we report a case of invasive vaginal carcinoma in a young woman who underwent fertility-sparing treatment involving neoadjuvant chemotherapy and conservative surgery. A 36-year-old non-parous woman had a solid tumor in the vagina. Positron emission tomography/computed tomography showed a tumor in the vagina with high FDG uptake (SUV = 17.33) but no metastatic lesions. The patient was diagnosed with vaginal squamous cell carcinoma, FIGO stage I, T1N0M0. Because she wished to retain her fertility, neoadjuvant chemotherapy consisting of irinotecan hydrochloride and nedaplatin was initiated. After four courses of chemotherapy, partial vaginectomy was carried out and the pathological diagnosis of the residual lesion was VAIN 3. Following two further courses of the same chemotherapy, she obtained complete response, and has shown no evidence of disease for 14 months. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  1. Does the emergency surgery score accurately predict outcomes in emergent laparotomies?

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    Peponis, Thomas; Bohnen, Jordan D; Sangji, Naveen F; Nandan, Anirudh R; Han, Kelsey; Lee, Jarone; Yeh, D Dante; de Moya, Marc A; Velmahos, George C; Chang, David C; Kaafarani, Haytham M A

    2017-08-01

    The emergency surgery score is a mortality-risk calculator for emergency general operation patients. We sought to examine whether the emergency surgery score predicts 30-day morbidity and mortality in a high-risk group of patients undergoing emergent laparotomy. Using the 2011-2012 American College of Surgeons National Surgical Quality Improvement Program database, we identified all patients who underwent emergent laparotomy using (1) the American College of Surgeons National Surgical Quality Improvement Program definition of "emergent," and (2) all Current Procedural Terminology codes denoting a laparotomy, excluding aortic aneurysm rupture. Multivariable logistic regression analyses were performed to measure the correlation (c-statistic) between the emergency surgery score and (1) 30-day mortality, and (2) 30-day morbidity after emergent laparotomy. As sensitivity analyses, the correlation between the emergency surgery score and 30-day mortality was also evaluated in prespecified subgroups based on Current Procedural Terminology codes. A total of 26,410 emergent laparotomy patients were included. Thirty-day mortality and morbidity were 10.2% and 43.8%, respectively. The emergency surgery score correlated well with mortality (c-statistic = 0.84); scores of 1, 11, and 22 correlated with mortalities of 0.4%, 39%, and 100%, respectively. Similarly, the emergency surgery score correlated well with morbidity (c-statistic = 0.74); scores of 0, 7, and 11 correlated with complication rates of 13%, 58%, and 79%, respectively. The morbidity rates plateaued for scores higher than 11. Sensitivity analyses demonstrated that the emergency surgery score effectively predicts mortality in patients undergoing emergent (1) splenic, (2) gastroduodenal, (3) intestinal, (4) hepatobiliary, or (5) incarcerated ventral hernia operation. The emergency surgery score accurately predicts outcomes in all types of emergent laparotomy patients and may prove valuable as a bedside decision

  2. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

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    Wang Fang

    2013-02-01

    Full Text Available Abstract Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS. Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p  1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively. The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively. Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in guiding the treatment of patients with asymptomatic recurrent ovarian cancer, who have shown CCR to primary therapy, can facilitate optimal secondary CRS and extend the survival duration of the patients.

  3. Comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting or correction of valvular heart disease.

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    Shvartz, Vladimir A; Kiselev, Anton R; Karavaev, Anatoly S; Vulf, Kristina A; Borovkova, Ekaterina I; Prokhorov, Mikhail D; Petrosyan, Andrey D; Bockeria, Olga L

    2018-01-01

    Introduction: Our aim was to perform a comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or surgical correction of valvular heart disease (SCVHD ). Methods: The synchronous 15 minutes records of heart rate variability (HRV) and finger's photoplethysmographic waveform variability (PPGV) were performed in 42 cardiac surgery patients (12 women) aged 61.8 ± 8.6 years (mean ± standard deviation), who underwent CABG, and 36 patients (16 women) aged 54.2 ± 14.9 years, who underwent SCVHD , before surgery and in 5-7 days after surgery. Conventional time and frequency domain measures of HRV and index S of synchronization between the slow oscillations in PPGV and HRV were analyzed. We also calculated personal dynamics of these indices after surgery. Results: We found no differences ( Р > 0.05) in all studied autonomic indices (preoperative and post-surgery) between studied patients' groups, except for the preoperative heart rate, which was higher in patients who underwent SCVHD ( P = 0.013). We have shown a pronounced preoperative and post-surgery variability (magnitude of inter-quartile ranges) of all autonomic indices in studied patients. In the cluster analysis based on cardiovascular autonomic indices (preoperative and post-surgery), we divided all patients into two clusters (38 and 40 subjects) which did not differ in all clinical characteristics (except for the preoperative hematocrit, P = 0.038), index S, and all post-surgery HRV indices. First cluster (38 patients) had higher preoperative values of the HR, TP, HF, and HF%, and lower preoperative values of the LF% and LF/HF. Conclusion: The variability of cardiovascular autonomic indices in on-pump cardiac surgery patients (two characteristic clusters were identified based on preoperative indices) was not associated with their clinical characteristics and features of surgical procedure (including cardioplegia).

  4. Interhospital transfer delays emergency abdominal surgery and prolongs stay.

    Science.gov (United States)

    Limmer, Alexandra M; Edye, Michael B

    2017-11-01

    Interhospital transfer of patients requiring emergency surgery is common practice. It has the potential to delay surgical intervention, increase rate of complications and thus length of hospital stay. A retrospective cohort study was conducted of adult patients who underwent emergency surgery for abdominal pain at a large metropolitan hospital in New South Wales (Hospital A) in 2013. The impact of interhospital transfer on time to surgical intervention, post-operative length of stay and overall length of stay was assessed. Of the 910 adult patients who underwent emergency surgery for abdominal pain at Hospital A in 2013, 31.9% (n = 290) were transferred by road ambulance from a local district hospital (Hospital B). The leading surgical procedures performed were appendicectomy (n = 299, 32.9%), cholecystectomy (n = 174, 19.1%), gastrointestinal endoscopy (n = 95, 10.4%), cystoscopy (n = 86, 9.5%), hernia repair (n = 45, 4.9%), salpingectomy (n = 19, 2.1%) and oversewing of perforated peptic ulcer (n = 13, 1.4%). Overall, interhospital transfer (n = 290, 31.9%) was associated with increases in mean time to surgical intervention (14.2 h, P < 0.001), post-operative length of stay (1.1 days, P = 0.001) and overall length of stay (1.6 days, P < 0.001). Delayed surgical intervention was observed across all procedure types except surgery for perforated peptic ulcer, where transferred patients underwent surgery within a comparable timeframe to direct admissions. Interhospital transfer delays surgical intervention and increases length of hospital stay. This mandates attention due to the implications for patient outcomes and added burden to the healthcare system. The system did, however, show capability to appropriately expedite surgery for acutely life-threatening cases. © 2016 Royal Australasian College of Surgeons.

  5. Epidural Hematoma and Abscess Related to Thoracic Epidural Analgesia: A Single-Center Study of 2,907 Patients Who Underwent Lung Surgery.

    Science.gov (United States)

    Kupersztych-Hagege, Elisa; Dubuisson, Etienne; Szekely, Barbara; Michel-Cherqui, Mireille; François Dreyfus, Jean; Fischler, Marc; Le Guen, Morgan

    2017-04-01

    To report the major complications (epidural hematoma and abscess) of postoperative thoracic epidural analgesia in patients who underwent lung surgery. Prospective, monocentric study. A university hospital. All lung surgical patients who received postoperative thoracic epidural analgesia between November 2007 and November 2015. Thoracic epidural analgesia for patients who underwent lung surgery. During the study period, data for 2,907 patients were recorded. The following 3 major complications were encountered: 1 case of epidural hematoma (0.34 case/1,000; 95% confidence interval 0.061-1.946), for which surgery was performed, and 2 cases of epidural abscesses (0.68 case/1,000; 95% confidence interval 0.189-2.505), which were treated medically. The risk range of serious complications was moderate; only the patient who experienced an epidural hematoma also experienced permanent sequelae. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery.

    Directory of Open Access Journals (Sweden)

    Gulinu Maimaituxun

    Full Text Available Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV in patients undergoing coronary artery bypass grafting (CABG remains unknown.Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57 who underwent CABG or non-coronary valvular surgery (non-CABG.In men, EATV, EATV index (EATV/body surface area and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP and type 2 diabetes mellitus (Corrected R2 = 0.262, p < 0.0001, while in women, type 2 diabetes mellitus is a single strong predictor for CABG, excluding EATV Index (Corrected R2 = 0.266, p = 0.005.Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.

  7. Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery.

    Science.gov (United States)

    Maimaituxun, Gulinu; Shimabukuro, Michio; Salim, Hotimah Masdan; Tabata, Minoru; Yuji, Daisuke; Morimoto, Yoshihisa; Akasaka, Takeshi; Matsuura, Tomomi; Yagi, Shusuke; Fukuda, Daiju; Yamada, Hirotsugu; Soeki, Takeshi; Sugimoto, Takaki; Tanaka, Masashi; Takanashi, Shuichiro; Sata, Masataka

    2017-01-01

    Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery (non-CABG). In men, EATV, EATV index (EATV/body surface area) and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP) and type 2 diabetes mellitus (Corrected R2 = 0.262, p EATV Index (Corrected R2 = 0.266, p = 0.005). Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.

  8. [Perioperative management of a child with central diabetes insipidus who underwent two surgeries before and after desmopressin administration].

    Science.gov (United States)

    Kiriyama, Keiji; Tachibana, Kazuya; Nishimura, Nobuyuki; Takeuchi, Muneyuki; Kinouchi, Keiko

    2013-03-01

    A 14-year-old girl weighing 32 kg was diagnosed with suprasellar tumor causing hydrocephalus, hypothyroidism, adrenal dysfunction and central diabetes insipidus. She was treated with levothyroxine and hydrocortisone and urged to take fluid to replace urine. She was scheduled to undergo ventricular drainage to relieve hydrocephalus prior to tumor resection. For the first surgery, desmopressin was not started and urine output reached 4,000 to 6,000 ml x day(-1), urine osmolality 64 mOsm x l(-1) and urine specific gravity 1.002. Anesthesia was induced with sevoflurane and maintained with propofol and remifentanil. Maintenance fluid was with acetated Ringer's solution and urine loss was replaced with 5% dextrose. Bradycardia and hypotension occurred after intubation, which was treated with volume load. Infusion volume was 750 ml and urine output was 1100 ml during 133 min of anesthesia. Postoperative day 1 nasal desmopressin was started. Ten days later, partial tumor resection was performed. Anesthesia was induced with propofol and fentanyl and maintained with sevoflurane and remifentanil. Infusion volume was 610 ml, urine output 380 ml, and blood loss 151 ml during 344 min of anesthesia. Hemodynamic parameters were stable throughout the procedure. Pathology of the tumor was revealed to be germinoma. Bradycardia and hypotension experienced during the first surgery was suspected to be caused by preoperative hypovolemia brought by polyuria. Desmopressin was proved to be effective to treat excessive urine output and to maintain good perioperative water balance.

  9. Emergency general surgery in the geriatric patient.

    Science.gov (United States)

    Desserud, K F; Veen, T; Søreide, K

    2016-01-01

    Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  10. [Emergency Surgery and Treatments for Pneumothorax].

    Science.gov (United States)

    Kurihara, Masatoshi

    2015-07-01

    The primary care in terms of emergency for pneumothorax is chest drainage in almost cases. The following cases of pneumothorax and the complications need something of surgery and treatments. Pneumothorax with subcutaneous emphysema often needs small skin incisions around the drainage tube. Tension pneumothorax often needs urgent chest drainage. Pneumothorax with intractable air leakage often needs interventional treatments like endobroncheal occlusion (EBO) or thoracographic fibrin glue sealing method (TGF) as well as urgent thoracoscopic surgery. Pneumothorax with acute empyema also often needs urgent thoracoscopic surgery within 2 weeks if chest drainage or drug therapy are unsuccessful. It will probably become chronic empyema of thorax after then. Pneumothorax with bleeding needs urgent thoracoscopic surgery in case of continuous bleeding over 200 ml/2 hours. In any cases of emergency for pneumothorax, respiratory physicians should collaborate with respiratory surgeons at the 1st stage because it is important to timely judge conversion of surgical treatments from medical treatments.

  11. Emergency thoracic surgery in elderly patients

    OpenAIRE

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants ...

  12. Emergency Surgery for Refractory Status Epilepticus.

    Science.gov (United States)

    Botre, Abhijeet; Udani, Vrajesh; Desai, Neelu; Jagadish, Spoorthy; Sankhe, Milind

    2017-08-15

    Management of refractory status epilepticus in children is extremely challenging. Two children with medically refractory status epilepticus, both of whom had lesional pathology on MRI and concordant data on EEG and PET scan. Emergency hemispherotomy performed in both patients. A complete, sustained seizure freedom obtained postoperatively. Emergency surgery is a treatment option in selected cases of drug refractory status epilepticus with lesional pathology and concordant data.

  13. The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital

    Directory of Open Access Journals (Sweden)

    Luciana Takata Pontes

    2015-11-01

    Full Text Available OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

  14. Changes in blood glucose level during and after light sedations using propofol-fentanyl and midazolam-fentanyl in diabetic patients who underwent cataract surgery.

    Science.gov (United States)

    Khalighinejad, Pooyan; Rahimi, Mojtaba; Naghibi, Khosro; Niknam, Negar

    2015-01-01

    Surgeries may trigger the stress response which leads to changes in blood glucose level, and studies suggest that different sedation and anesthesia methods have different effects on blood glucose level. The aim of this study was to investigate changes of blood glucose levels in diabetic patients and compare them in two sedation methods of propofol + fentanyl and midazolam + fentanyl. Totally, 80 diabetic candidates for cataract surgery who had all the inclusion criteria, underwent cataract surgery using two methods of propofol (1 mg/kg/h) + fentanyl (2 μg/kg) (Group P) and midazolam (0.03 mg/kg) + fentanyl (2 μg/kg) (Group M) for light sedation. In the end, 70 patients (Group P n = 35 and Group M n = 35) remained in the study. Patients' blood glucose levels, vital signs, and hemodynamic data were assessed 30 min prior to the surgery, each 15 min during surgery and at the end of surgery. Hemodynamic parameters did not have a statistically significant difference between the two groups mean blood glucose level in Group M was 149.15 mg/dl and in Group P was 149.2 mg/dl, and based on repeated measures analysis of variance test, significant differences were not observed between the two groups (P = 0.99). T-test showed no significant differences in the blood glucose level at any time of the study between the two groups. Light sedation methods of propofol + fentanyl and midazolam + fentanyl did not have any differences in alteration of blood glucose level.

  15. Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

    Science.gov (United States)

    Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2018-04-01

    The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery

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    Cristian Lupascu

    2017-01-01

    Full Text Available Introduction. During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. Methods. From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34–82, 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57–70 underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. Results. All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5. The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14–23. Conclusion. Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.

  17. Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery.

    Science.gov (United States)

    Lupascu, Cristian; Trofin, Ana; Zabara, Mihai; Vornicu, Alexandra; Cadar, Ramona; Vlad, Nutu; Apopei, Oana; Grigorean, Valentin; Lupascu-Ursulescu, Corina

    2017-01-01

    During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34-82), 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57-70) underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5). The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14-23). Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy) are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.

  18. Emergency thoracic surgery in elderly patients

    Science.gov (United States)

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants Emergency patients treated at the Department of Thoracic Surgery, University Hospital of Luebeck, Germany. Main outcome measures Co-morbidities, mortality, risk factors and hospital length of stay. Results A total of 124 thoracic procedures were performed on 114 patients. There were 79 men and 36 women (average age 72.5 ±6.4 years, range 65–94). The overall operative mortality was 25.4%. The most frequent indication was thoracic/mediastinal infection, followed by peri- or postoperative thoracic complications. Risk factors for hospital mortality were a high ASA score, pre-existing diabetes mellitus and renal insufficiency. Conclusions Our study documents a perioperative mortality rate of 25% in patients over 65 who required emergency thoracic surgery. The main indication for a surgical intervention was sepsis with a thoracic/mediastinal focus. Co-morbidities and the resulting perioperative complications were found to have a significant effect on both inpatient length of stay and outcome. Long-term systemic co-morbidities such as diabetes mellitus are difficult to equalize with respect to certain organ dysfunctions and significantly increase mortality. PMID:21369531

  19. The Effect of Two Different Hand Exercises on Grip Strength, Forearm Circumference, and Vascular Maturation in Patients Who Underwent Arteriovenous Fistula Surgery

    Science.gov (United States)

    Kong, Sangwon; Lee, Kyung Soo; Kim, Junho

    2014-01-01

    Objective To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery. Methods We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb. Results All of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups. Conclusion The results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball. PMID:25379494

  20. A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP).

    Science.gov (United States)

    Kim, J Y; Bae, H S

    2001-01-01

    Despite recent advances in the treatment of advanced gastric carcinomas, no satisfactory outcomes are available because of micrometastases and free-floating carcinoma cells already existing in the peritoneal cavity. From 1990, we started using intraperitoneal hyperthermo-chemo-perfusion (IHCP) to prevent and to treat peritoneal metastasis after surgical resection of stomach cancer. We analyzed 103 serosa-invasive gastric carcinoma patients who underwent surgical resection between 1990 and 1995. Fifty-two patients who received surgery plus IHCP were compared with 51 patients who underwent surgery only, as controls. IHCP was administered for 2 h with an automatic IHCP device (closed-circuit system) just after surgical resection, with the patient under hypothermic general anesthesia (32.4 degrees C-34.0 degrees C). As perfusate, we used 1.5% peritoneal dialysis solution mixed with 10 micrograms/ml of mitomycin-C (MMC), warmed at an inflow temperature of over 44 degrees C. The overall 5-year survival rate (5-YSR) of the 103 patients was 29.97%. The 5-YSR was higher in the IHCP group than in the control group, at 32.7% and 27.1%, respectively, but this difference was not significant. However, in the 65 serosa-invasive gastric carcinoma patients (excluding those in stage IV) the 5-YSR was significantly higher (P = 0.0379) in the IHCP group than in the control group, at 58.6% and 44.4%, respectively. On multivariate analysis of all 103 patients, depth of tumor invasion and lymph node metastasis were significant factors for survival, whereas significant factors on univariate analysis, such as combined operation, distant metastasis, and peritoneal metastasis, were not significant. The most common recurrence patterns were loco-regional in the IHCP group and peritoneal in the control group. Complete cytoreductive surgery plus IHCP is effective to prevent and to treat peritoneal metastasis, and it should lead to long-term survival for serosa-invasive gastric carcinoma patients

  1. A New Risk Factor Profile for Contrast-Induced Acute Kidney Injury in Patients Who Underwent an Emergency Percutaneous Coronary Intervention.

    Science.gov (United States)

    Yuan, Ying; Qiu, Hong; Song, Lei; Hu, Xiaoying; Luo, Tong; Zhao, Xueyan; Zhang, Jun; Wu, Yuan; Qiao, Shubin; Yang, Yuejin; Gao, Runlin

    2018-07-01

    We developed a new risk factor profile for contrast-induced acute kidney injury (CI-AKI) under a new definition in patients who underwent an emergency percutaneous coronary intervention (PCI). Consecutive patients (n = 1061) who underwent an emergency PCI were divided into a derivation group (n = 761) and a validation group (n = 300). The rates of CI-AKI were 23.5% (definition 1: serum creatinine [SCr] increase ≥25% in 72 hours), 4.3% (definition 2: SCr increase ≥44.2 μmol/L in 72 hours), and 7.0% (definition 3: SCr increase ≥44.2 μmol/L in 7 days). Due to the high sensitivity of definition 1 and the high rate of missed cases for late diagnosis of CI-AKI under definition 2, definition 3 was used in the study. The risk factor profile included body surface area 15.00 × 10 9 /L ( P = .047), estimated glomerular filtration rate 133 μmol/L ( P = .007), intra-aortic balloon pump application ( P = .006), and diuretics administration ( P risk factor profile of CI-AKI under a new CI-AKI definition in emergency PCI patients is easily applicable with a useful predictive value.

  2. Diagnosis of accessory conduction pathway using ECG-gated emission CT analysis. Studies in patients with WPW syndrome who underwent surgery

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    Misaki, Takuro; Mukai, Keiichi; Tsubota, Makoto; Iwa, Takashi; Nakajima, Ken-ichi; Hisada, Kin-ichi

    1987-09-01

    Pinpointing the location of accessory conduction pathway (ACP) is of great importance in the surgical treatment for Wolff-Parkinson-White (WPW) syndrome. For this purpose, this study explored the usefulness of ECG-gated emission computed tomography (Gated-ECT) in 30 patients who preoperatively underwent Gated-ECT. The site of earliest contraction at level of atrioventicular valves, obtained on tomographic phase analysis, was compared with the site of earliest activation, obtained on epicardial mapping during surgery. The concordance rate of the two methods was 94 % (28/30). Among them, one patient was found to have the association of corrected transposition of great arteries on Gated-ECT. Gated-ECT was, however, of limited value in differentiating right posterior ACP from right postseptal ACP. The discordance between the sites of earliest contraction and activation, which was observed in the two others, was likely due to decreased wall motion resulting from myocardial disturbance. Gated-ECT may have a diagnostic potential for the location of ACP, especially in view of providing images that corresponded to the surgical anatomy. (Namekawa, K.).

  3. Differences in emergency colorectal surgery in Medicaid and uninsured patients by hospital safety net status.

    Science.gov (United States)

    Bradley, Cathy J; Dahman, Bassam; Sabik, Lindsay M

    2015-02-01

    We examined whether safety net hospitals reduce the likelihood of emergency colorectal cancer (CRC) surgery in uninsured and Medicaid-insured patients. If these patients have better access to care through safety net providers, they should be less likely to undergo emergency resection relative to similar patients at non- safety net hospitals. Using population-based data, we estimated the relationship between safety net hospitals, patient insurance status, and emergency CRC surgery. We extracted inpatient admission data from the Virginia Health Information discharge database and matched them to the Virginia Cancer Registry for patients aged 21 to 64 years who underwent a CRC resection between January 1, 1999, and December 31, 2005 (n = 5488). We differentiated between medically defined emergencies and those that originated in the emergency department (ED). For each definition of emergency surgery, we estimated the linear probability models of the effects of being treated at a safety net hospital on the probability of having an emergency resection. Safety net hospitals reduce emergency surgeries among uninsured and Medicaid CRC patients. When defining an emergency resection as those that involved an ED visit, these patients were 15 to 20 percentage points less likely to have an emergency resection when treated in a safety net hospital. Our results suggest that these hospitals provide a benefit, most likely through the access they afford to timely and appropriate care, to uninsured and Medicaid-insured patients relative to hospitals without a safety net mission.

  4. The ongoing emergence of robotics in plastic and reconstructive surgery.

    Science.gov (United States)

    Struk, S; Qassemyar, Q; Leymarie, N; Honart, J-F; Alkhashnam, H; De Fremicourt, K; Conversano, A; Schaff, J-B; Rimareix, F; Kolb, F; Sarfati, B

    2018-04-01

    Robot-assisted surgery is more and more widely used in urology, general surgery and gynecological surgery. The interest of robotics in plastic and reconstructive surgery, a discipline that operates primarily on surfaces, has yet to be conclusively proved. However, the initial applications of robotic surgery in plastic and reconstructive surgery have been emerging in a number of fields including transoral reconstruction of posterior oropharyngeal defects, nipple-sparing mastectomy with immediate breast reconstruction, microsurgery, muscle harvesting for pelvic reconstruction and coverage of the scalp or the extremities. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  5. Outcome of Emergency Abdominal Surgery at Kigali University ...

    African Journals Online (AJOL)

    There is little information regarding the clinical spectrum of disease in these patients ... was a case series study of 229 patients who underwent emergency abdominal ... The most common operative findings were peritonitis (41.5%), intestinal ...

  6. Enhanced Recovery After Surgery (ERAS) - The Evidence in Geriatric Emergency Surgery

    DEFF Research Database (Denmark)

    Paduraru, Mihai; Ponchietti, Luca; Casas, Isidro Martinez

    2017-01-01

    Background: Geriatric surgery is rising and projected to continue at a greater rate. There is already concern about the poor outcomes for the emergency surgery in elderly. How to manage the available resources to improve outcomes in this group of patients is an important object of debate...... to conventional care. Emergency surgical patients also had fewer postoperative complications with ERAS compared to conventional care. Hospital stay was reduced in 2 out of 3 studies for emergency surgery.Conclusions:ERAS can be safely applied to elderly and emergency patients with a reduction in postoperative....... OBJECTIVES: We aimed to determine the feasibility and safety of applying ERAS pathways to emergency elderly surgical patients. METHOD: Two searches were undertaken for ERAS protocols in elderly patients and emergency surgery, in order to gather evidence in relation to ERAS in geriatric emergency patients...

  7. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

    Science.gov (United States)

    Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

    2011-11-01

    To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for

  8. Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery

    Energy Technology Data Exchange (ETDEWEB)

    Deshmukh, Swati D.; Shin, David S.; Willmann, Juergen K.; Rosenberg, Jarrett; Shin, Lewis; Jeffrey, R.B. [Stanford University, School of Medicine, Department of Radiology, Stanford, CA (United States)

    2011-05-15

    To identify CT findings predictive of surgical management in non-emergency small bowel obstruction (SBO). Contrast-enhanced abdominal CT of 129 patients with non-emergency SBO were evaluated for small bowel luminal diameter, wall thickness, presence of the small bowel faeces sign (intraluminal particulate matter in a dilated small bowel) and length, transition point, submucosal oedema, mesenteric stranding, ascites and degree of obstruction (low grade partial, high grade partial and complete obstruction). Medical records were reviewed for age, gender, management and history of abdominal surgery, abdominal malignancy, or SBO. Statistical analyses were performed with Stata Release 9.2. Degree of obstruction was the only predictor of need for surgery. Whereas 18.0% of patients with low-grade partial obstruction (n = 50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n = 77) and 100% of patients with complete obstruction (n = 2) required surgery (P = 0.004). The small bowel faeces sign was inversely predictive of surgery (P = 0.018). In non-emergency SBO patients with contrast-enhanced CT imaging, grade of obstruction predicts surgery, while the small bowel faeces sign inversely predicts need for surgery. (orig.)

  9. Outcomes following major emergency gastric surgery: the importance of specialist surgeons.

    Science.gov (United States)

    Khan, O A; McGlone, E R; Mercer, S J; Somers, S S; Toh, S K C

    2015-01-01

    The increasing subspecialisation of general surgeons in their elective work may result in problems for the provision of expert care for emergency cases. There is very little evidence of the impact of subspecialism on outcomes following emergency major upper gastrointestinal surgery. This prospective study investigated whether elective subspecialism of general surgeon is associated with a difference in outcome following major emergency gastric surgery. Between February 1994 and June 2010, the data from all emergency major gastric procedures (defined as patients who underwent laparotomy within 12 hours of referral to the surgical service for bleeding gastroduodenal ulcer and/or undergoing major gastric resection) was prospectively recorded. The sub-specialty interest of operating surgeon was noted and related to post-operative outcomes. Over the study period, a total of 63 major gastric procedures were performed of which 23 (37%) were performed by specialist upper gastrointestinal (UGI) consultants. Surgery performed by a specialist UGI surgeon was associated with a significantly lower surgical complication (4% vs. 28% of cases; p=0.04) and in-patient mortality rate (22% vs. 50%; p=0.03). Major emergency gastric surgery has significantly better clinical outcomes when performed by a specialist UGI surgeon. These results have important implications for provision of an emergency general surgical service. Copyright© Acta Chirurgica Belgica.

  10. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

    Directory of Open Access Journals (Sweden)

    Choi Eun

    2010-05-01

    Full Text Available Abstract Background The aim of this study was to assess the results of curative surgery with and without radiotherapy in patients with T1-2N0-1 oral tongue squamous cell carcinoma (OSCC and to evaluate survival and prognostic factors. Methods Retrospective analysis of 86 patients with T1-2N0-1 OSCC who received surgery between January 2000 and December 2006. Fourteen patients (16.3% received postoperative radiotherapy (PORT. Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were analyzed. Results The median follow-up was 45 months. The five-year overall survival (OS and disease-free survival (DFS rates were 80.8% and 80.2%, respectively. Higher tumor grade and invasion depth ≥ 0.5 cm were the significant prognostic factors affecting five-year OS and DFS (OS rate; 65% vs. 91%, p = 0.001 for grade; 66% vs. 92%, p = 0.01 for invasion depth: DFS rate; 69% vs. 88%, p = 0.005 for grade; 66% vs. 92%, p = 0.013 for invasion depth. In the risk group, there was no local failure in patients with postoperative radiotherapy. Conclusions In T1-2N0-1 OSCC, factors that affected prognosis after primary surgery were higher tumor grade and deep invasion depth over 0.5 cm. Postoperative radiotherapy should be considered in early oral tongue cancer patients with these high-risk pathologic features.

  11. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

    International Nuclear Information System (INIS)

    Shim, Su Jung; Cha, Jihye; Koom, Woong Sub; Kim, Gwi Eon; Lee, Chang Geol; Choi, Eun Chang; Keum, Ki Chang

    2010-01-01

    The aim of this study was to assess the results of curative surgery with and without radiotherapy in patients with T 1-2 N 0-1 oral tongue squamous cell carcinoma (OSCC) and to evaluate survival and prognostic factors. Retrospective analysis of 86 patients with T 1-2 N 0-1 OSCC who received surgery between January 2000 and December 2006. Fourteen patients (16.3%) received postoperative radiotherapy (PORT). Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were analyzed. The median follow-up was 45 months. The five-year overall survival (OS) and disease-free survival (DFS) rates were 80.8% and 80.2%, respectively. Higher tumor grade and invasion depth ≥ 0.5 cm were the significant prognostic factors affecting five-year OS and DFS (OS rate; 65% vs. 91%, p = 0.001 for grade; 66% vs. 92%, p = 0.01 for invasion depth: DFS rate; 69% vs. 88%, p = 0.005 for grade; 66% vs. 92%, p = 0.013 for invasion depth). In the risk group, there was no local failure in patients with postoperative radiotherapy. In T 1-2 N 0-1 OSCC, factors that affected prognosis after primary surgery were higher tumor grade and deep invasion depth over 0.5 cm. Postoperative radiotherapy should be considered in early oral tongue cancer patients with these high-risk pathologic features

  12. Use of National Burden to Define Operative Emergency General Surgery.

    Science.gov (United States)

    Scott, John W; Olufajo, Olubode A; Brat, Gabriel A; Rose, John A; Zogg, Cheryl K; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2016-06-15

    Emergency general surgery (EGS) represents 11% of surgical admissions and 50% of surgical mortality in the United States. However, there is currently no established definition of the EGS procedures. To define a set of procedures accounting for at least 80% of the national burden of operative EGS. A retrospective review was conducted using data from the 2008-2011 National Inpatient Sample. Adults (age, ≥18 years) with primary EGS diagnoses consistent with the American Association for the Surgery of Trauma definition, admitted urgently or emergently, who underwent an operative procedure within 2 days of admission were included in the analyses. Procedures were ranked to account for national mortality and complication burden. Among ranked procedures, contributions to total EGS frequency, mortality, and hospital costs were assessed. The data query and analysis were performed between November 15, 2015, and February 16, 2016. Overall procedure frequency, in-hospital mortality, major complications, and inpatient costs calculated per 3-digit International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. The study identified 421 476 patient encounters associated with operative EGS, weighted to represent 2.1 million nationally over the 4-year study period. The overall mortality rate was 1.23% (95% CI, 1.18%-1.28%), the complication rate was 15.0% (95% CI, 14.6%-15.3%), and mean cost per admission was $13 241 (95% CI, $12 957-$13 525). After ranking the 35 procedure groups by contribution to EGS mortality and morbidity burden, a final set of 7 operative EGS procedures were identified, which collectively accounted for 80.0% of procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs nationwide. These 7 procedures included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. Only 7 procedures account

  13. Changing trend in emergency surgery for perforated duodenal ulcer

    International Nuclear Information System (INIS)

    Gurteyik, E.

    2003-01-01

    Objective: To evaluate changes in the emergency surgery of the duodenal ulcer. Subjects and Methods: Hospital records of 523 surgically treated patients, with duodenal ulcer perforation, during the period of 25 years 91975-1999) in the same surgical department, was retrospectively analysed. Changing aspects of emergency surgery of peptic ulcer disease, in the recent period, were determined in respect to number of operations per year and in the choice of operative methods. Results: The average number of patients and emergency operations per year was 21. No significant change was observed during the study period. Elective operations gradually decreased in the last ten years, and none was performed in the last 4 years. On the other hand, 226 emergency interventions for duodenal ulcer perforation were performed in the last ten years and 84 interventions in the last 4 years. Definitive anti-ulcer surgery was performed in 42% of patients between 1985 and 1994. Simple closure of the perforation plus treatment with proton pump inhibitors and with anti-Helicobacter pylori medication was the method in 80% during the last year. Conclusion: Emergency surgery for perforated duodenal ulcer preserves its steady rate despite disappearance of elective operations after tremendous progress in medical control of peptic ulcer disease. There is an obvious return from definitive anti-ulcer surgery to simple closure of the perforation followed by antisecretory and antibacterial medications in the recent years. (author)

  14. Emergency abdominal surgery in Zaria, Nigeria

    African Journals Online (AJOL)

    high rate of emergency operations could be due to the large number of trauma ... of sanitation, which may trigger lymphoid tissue reaction in the appendix wall and .... future surgical training and help surgeons who practise in our setting to ...

  15. Comportamiento de los pacientesancianosoperados de cirugíacardíaca con circulaciónextracorpórea/ Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2015-10-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks. Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass. Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014. Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively. Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  16. Emergency surgery due to complications during molecular targeted therapy in advanced gastrointestinal stromal tumors (GIST)

    International Nuclear Information System (INIS)

    Rutkowski, P.; Nowecki, Z. I.; Dziewirski, W.; Ruka, W.; Siedlecki, J. A.; Grzesiakowska, U.

    2010-01-01

    Aim. The aim of the study was to assess the frequency and results of disease/treatment-related emergency operations during molecular targeted therapy of advanced gastrointestinal stromal tumors (GISTs). Methods. We analyzed emergency operations in patients with metastatic/inoperable GISTs treated with 1 st -line imatinib - IM (group I: 232 patients; median follow-up time 31 months) and 2 nd -line sunitinib - SU (group II: 43 patients; median follow-up 13 months; 35 patients in trial A6181036) enrolled into the Polish Clinical GIST Registry. Results. In group I 3 patients (1.3%) underwent emergency surgery due to disease/treatment related complications: one due to bleeding from a ruptured liver tumor (1 month after IM onset) and two due to bowel perforation on the tumor with subsequent intraperitoneal abscess (both 2 months after IM onset). IM was restarted 5-8 days after surgery and no complications in wound healing were observed. In group II 4 patients (9.5%) underwent emergency operations due to disease/treatment related complications: three due to bowel perforations on the tumor (2 days, 20 days and 10 months after SU onset; 1 subsequent death) and one due to intraperitoneal bleeding from ruptured, necrotic tumor (3.5 months after SU start). SU was restarted 12-18 days after surgery and no complications in wound healing were observed. Conclusions. Emergency operations associated with disease or therapy during imatinib treatment of advanced GISTs are rare. The frequency of emergency operations during sunitinib therapy is considered to be higher than during first line therapy with imatinib which may be associated with more advanced and more resistant disease or to the direct mechanism of sunitinib action, i.e. combining cytotoxic and antiangiogenic activity and thus leading to dramatic tumor response. Molecular targeted therapy in GISTs should always be conducted in cooperation with an experienced surgeon. (authors)

  17. Low-Level Laser and Light-Emitting Diode Therapy for Pain Control in Hyperglycemic and Normoglycemic Patients Who Underwent Coronary Bypass Surgery with Internal Mammary Artery Grafts: A Randomized, Double-Blind Study with Follow-Up.

    Science.gov (United States)

    Lima, Andréa Conceição Gomes; Fernandes, Gilderlene Alves; Gonzaga, Isabel Clarisse; de Barros Araújo, Raimundo; de Oliveira, Rauirys Alencar; Nicolau, Renata Amadei

    2016-06-01

    This study aimed to evaluate the efficacy of low-level laser therapy (LLLT) and light-emitting diodes (LEDs) for reducing pain in hyperglycemic and normoglycemic patients who underwent coronary artery bypass surgery with internal mammary artery grafts. This study was conducted on 120 volunteers who underwent elective coronary artery bypass graft (CABG) surgery. The volunteers were randomly allocated to four different groups of equal size (n = 30): control, placebo, LLLT [λ = 640 nm and spatial average energy fluence (SAEF) = 1.06 J/cm(2)], and LED (λ = 660 ± 20 nm and SAEF = 0.24 J/cm(2)). Participants were also divided into hyperglycemic and normoglycemic subgroups, according to their fasting blood glucose test result before surgery. The outcome assessed was pain during coughing by a visual analog scale (VAS) and the McGill Pain Questionnaire. The patients were followed for 1 month after the surgery. The LLLT and LED groups showed a greater decrease in pain, with similar results, as indicated by both the VAS and the McGill questionnaire (p ≤ 0.05), on the 6th and 8th postoperative day compared with the placebo and control groups. The outcomes were also similar between hyperglycemic and normoglycemic patients. One month after the surgery, almost no individual reported pain during coughing. LLLT and LED had similar analgesic effects in hyperglycemic and normoglycemic patients, better than placebo and control groups.

  18. Improving outcomes of emergency bowel surgery using nela model

    International Nuclear Information System (INIS)

    Sultan, R.; Zafar, H.

    2018-01-01

    To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA). Study Design:An audit. Place and Duration of Study:Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014. Methodology:Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their first report. P-value for categorical variables was calculated using Chi-square tests. Results:Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantly more than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lacking in terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperative goal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients and review of elderly patients by MCOP specialist. Conclusion:This study helped in understanding the deficiencies in the care of patients undergoing emergency bowel surgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to do interventions in the deficient areas to improve care given to these patients and their outcomes with the limited resources of a developing country. (author)

  19. Understanding the "Weekend Effect" for Emergency General Surgery.

    Science.gov (United States)

    Hoehn, Richard S; Go, Derek E; Dhar, Vikrom K; Kim, Young; Hanseman, Dennis J; Wima, Koffi; Shah, Shimul A

    2018-02-01

    Several studies have identified a "weekend effect" for surgical outcomes, but definitions vary and the cause is unclear. Our aim was to better characterize the weekend effect for emergency general surgery using mortality as a primary endpoint. Using data from the University HealthSystem Consortium from 2009 to 2013, we identified urgent/emergent hospital admissions for seven procedures representing 80% of the national burden of emergency general surgery. Patient characteristics and surgical outcomes were compared between cases that were performed on weekdays vs weekends. Hospitals varied widely in the proportion of procedures performed on the weekend. Of the procedures examined, four had higher mortality for weekend cases (laparotomy, lysis of adhesions, partial colectomy, and small bowel resection; p < 0.01), while three did not (appendectomy, cholecystectomy, and peptic ulcer disease repair). Among the four procedures with increased weekend mortality, patients undergoing weekend procedures also had increased severity of illness and shorter time from admission to surgery (p < 0.01). Multivariate analysis adjusting for patient characteristics demonstrated independently higher mortality on weekends for these same four procedures (p < 0.01). For the first time, we have identified specific emergency general surgery procedures that incur higher mortality when performed on weekends. This may be due to acute changes in patient status that require weekend surgery or indications for urgent procedures (ischemia, obstruction) compared to those without a weekend mortality difference (infection). Hospitals that perform weekend surgery must acknowledge and identify ways to manage this increased risk.

  20. Macula-Sparing rhegmatogenous retinal detachment: Is emergent surgery necessary?

    Directory of Open Access Journals (Sweden)

    Sasan Mahmoudi

    2016-01-01

    Full Text Available The status of the macula is a significant factor in determining final visual outcomes in rhegmatogenous retinal detachment (RRD and should be considered in the timing of surgical repair. Several studies have shown that macula-involving RRDs attain similar visual and anatomic outcomes when surgery is performed within seven days as compared to emergent surgery (within 24 hours. In contrast, surgery prior to macular detachment in macula-sparing RRDs generally yields the best visual outcomes. In the case of macula-sparing RRDs, it is not clear how long the macula may remain attached, therefore, standard practice dictates emergent surgery. Timing of presentation, examination findings, case complexity, co-existing medical conditions, surgeon expertise, and timing and quality of access to operating facilities and staff, however, should all be considered in determining whether a macula-sparing RRD requires immediate intervention or if equivalent visual and possibly better overall outcomes can be achieved with scheduled surgery within an appropriate time frame.

  1. Mesenteric panniculitis patients requiring emergency surgery: report of three cases.

    Science.gov (United States)

    Duman, Mustafa; Koçak, Osman; Fazli, Olgaç; Koçak, Cengiz; Atici, Ali Emre; Duman, Uğur

    2012-04-01

    Mesenteric panniculitis is a rare, benign disease characterized by a chronic non-specific inflammatory process of mesenteric fat tissue with unknown etiology. The small bowel mesentery is affected mostly. This process rarely involves the large intestine mesentery. Mesenteric panniculitis includes symptoms as abdominal pain, nausea and vomiting, diarrhea, constipation, and fever. In our cases, we had difficulty in the preoperative diagnosis as the clinical changes imitated an obstruction or ischemia of the small bowel. All the cases required emergency abdominal surgery and partial jejunal resection. The aim of this article was to present three cases of mesenteric panniculitis of the small bowel mesentery requiring emergency surgery together with a short review of the literature.

  2. Enhanced Recovery after Emergency Surgery: A Systematic Review.

    Science.gov (United States)

    Paduraru, Mihai; Ponchietti, Luca; Casas, Isidro Martinez; Svenningsen, Peter; Zago, Mauro

    2017-04-01

    To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS). We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; after eliminating the papers not meeting search criteria, we selected 4 cohort studies and 1 randomized clinical trial (RCT). Data extracted for analysis consisted of: patient age, type of surgery performed, ERAS elements implemented, surgical outcomes in terms of postoperative complications, mortality, length of stay (LOS) and readmission rate. The number of ERAS items applied was good, ranging from 11 to 18 of the 20 recommended by the ERAS Society. The implementation resulted in fewer postoperative complications. LOS for ES patients was shorter when compared to conventional care. Mortality, specifically reported in three studies, was equal or lower with ERAS. Readmission rates varied widely and were generally higher for the intervention group but without statistical significance. The studies reviewed agreed that ERAS in emergency surgery (ES) was feasible and safe with generally better outcomes. Lower compliance with some of the ERAS items shows the need for the protocol to be adapted to ES patients. More evidence is clearly required as to what can improve outcomes and how this can be formulated into an effective care pathway for the heterogeneous ES patient.

  3. Emergency general surgery: definition and estimated burden of disease.

    Science.gov (United States)

    Shafi, Shahid; Aboutanos, Michel B; Agarwal, Suresh; Brown, Carlos V R; Crandall, Marie; Feliciano, David V; Guillamondegui, Oscar; Haider, Adil; Inaba, Kenji; Osler, Turner M; Ross, Steven; Rozycki, Grace S; Tominaga, Gail T

    2013-04-01

    Acute care surgery encompasses trauma, surgical critical care, and emergency general surgery (EGS). While the first two components are well defined, the scope of EGS practice remains unclear. This article describes the work of the American Association for the Surgery of Trauma to define EGS. A total of 621 unique International Classification of Diseases-9th Rev. (ICD-9) diagnosis codes were identified using billing data (calendar year 2011) from seven large academic medical centers that practice EGS. A modified Delphi methodology was used by the American Association for the Surgery of Trauma Committee on Severity Assessment and Patient Outcomes to review these codes and achieve consensus on the definition of primary EGS diagnosis codes. National Inpatient Sample data from 2009 were used to develop a national estimate of EGS burden of disease. Several unique ICD-9 codes were identified as primary EGS diagnoses. These encompass a wide spectrum of general surgery practice, including upper and lower gastrointestinal tract, hepatobiliary and pancreatic disease, soft tissue infections, and hernias. National Inpatient Sample estimates revealed over 4 million inpatient encounters nationally in 2009 for EGS diseases. This article provides the first list of ICD-9 diagnoses codes that define the scope of EGS based on current clinical practices. These findings have wide implications for EGS workforce training, access to care, and research.

  4. Disparities in access to emergency general surgery care in the United States.

    Science.gov (United States)

    Khubchandani, Jasmine A; Shen, Connie; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

    2018-02-01

    As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery.

    Science.gov (United States)

    Du, Yang; Karvellas, Constantine J; Baracos, Vickie; Williams, David C; Khadaroo, Rachel G

    2014-09-01

    With the increasing aging population, the number of very elderly patients (age ≥80 years) undergoing emergency operations is increasing. Evaluating patient-specific risk factors for postoperative morbidity and mortality in the acute care surgery setting is crucial to improving outcomes. We hypothesize that sarcopenia, a severe depletion of skeletal muscles, is a predictor of morbidity and mortality in very elderly patients undergoing emergency surgery. A total of 170 patients older than the age of 80 underwent emergency surgery between 2008 and 2010 at a tertiary care facility; 100 of these patients had abdominal computed tomography images within 30 days of the operation that were adequate for the assessment of sarcopenia. The impact of sarcopenia on the operative outcomes was evaluated using both univariate and multivariate analysis. The mean patient age was 84 years, with an in-hospital mortality of 18%. Sarcopenia was present in 73% of patients. More sarcopenic patients had postoperative complications (45% sarcopenic versus 15% nonsarcopenic, P = .005) and more died in hospital (23 vs 4%, P = .037). There were no differences in duration of stay or requirement for intensive care unit postoperatively. After we controlled for confounding factors, increasing skeletal muscle index (per incremental cm(2)/m(2)) was associated with decreased in-hospital mortality (odds ratio ∼0.834, 95% confidence interval 0.731-0.952, P = .007) in multivariate analysis. Sarcopenia was independently predictive of greater complication rates, discharge disposition, and in-hospital mortality in the very elderly emergency surgery population. Using sarcopenia as an objective tool to identify high-risk patients would be beneficial in developing tailored preventative strategies and potentially resource allocation in the future. Copyright © 2014 Mosby, Inc. All rights reserved.

  6. Emergency surgery for lung cancer with abscess formation after transbronchial biopsy.

    Science.gov (United States)

    Takanashi, Yusuke; Miyashita, Koichi; Tajima, Shogo; Hayakawa, Takamitsu; Neyatani, Hiroshi; Funai, Kazuhito

    2017-03-01

    Abscess formation in lung cancer after transbronchial biopsy (TBB) is a rare complication with no standard consensus on a coping strategy or prophylaxis. We describe an instructive case of lung cancer which developed into an abscess after TBB. An 80-year-old man with poorly controlled diabetes mellitus underwent TBB for diagnosing a mass lesion in the left upper lobe. The TBB specimen confirmed a diagnosis of lung cancer, and he was scheduled for radical surgery. However, the tumour was revealed to have progressed into an enlarged abscess 24 days after TBB. Prompt use of meropenem failed to relieve the infection, hence we performed emergency left upper lobectomy. Poorly controlled diabetes mellitus was considered to be a risk for the formation of a tumour abscess after TBB. It was difficult to control the infection with conservative treatment using antibiotics; emergency surgical resection was considered to be the safest strategy for recovery.

  7. Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa.

    Science.gov (United States)

    Chowdhury, Sharfuddin; Nicol, Andrew John; Moydien, Mahammed Riyaad; Navsaria, Pradeep Harkison; Montoya-Pelaez, Luis Felipe

    2018-01-01

    The optimal timing for emergency surgical interventions and implementation of protocols for trauma surgery is insufficient in the literature. The Groote Schuur emergency surgery triage (GSEST) system, based on Cape Triaging Score (CTS), is followed at Groote Schuur Hospital (GSH) for triaging emergency surgical cases including trauma cases. The study aimed to look at the effect of delay in surgery after scheduling based on the GSEST system has an impact on outcome in terms of postoperative complications and death. Prospective audit of patients presenting to GSH trauma center following penetrating or blunt chest, abdominal, neck and peripheral vascular trauma who underwent surgery over a 4-month period was performed. Post-operative complications were graded according to Clavien-Dindo classification of surgical complications. One-hundred six patients underwent surgery during the study period. One-hundred two (96.2%) cases were related to penetrating trauma. Stab wounds comprised 71 (67%) and gunshot wounds (GSW) 31 (29.2%) cases. Of the 106 cases, 6, 47, 40, and 13 patients were booked as red, orange, yellow, and green, respectively. The median delay for green, yellow, and orange cases was within the expected time. The red patients took unexpectedly longer (median delay 48 min, IQR 35-60 min). Thirty-one (29.3%) patients developed postoperative complications. Among the booked red, orange, yellow, and green cases, postoperative complications developed in 3, 18, 9, and 1 cases, respectively. Only two (1.9%) postoperative deaths were documented during the study period. There was no statistically significant association between operative triage and post-operative complications ( p  = 0.074). Surgical case categorization has been shown to be useful in prioritizing emergency trauma surgical cases in a resource constraint high-volume trauma center.

  8. Acute care surgery: defining mortality in emergency general surgery in the state of Maryland.

    Science.gov (United States)

    Narayan, Mayur; Tesoriero, Ronald; Bruns, Brandon R; Klyushnenkova, Elena N; Chen, Hegang; Diaz, Jose J

    2015-04-01

    Emergency general surgery (EGS) is a major component of acute care surgery, however, limited data exist on mortality with respect to trauma center (TC) designation. We hypothesized that mortality would be lower for EGS patients treated at a TC vs non-TC (NTC). A retrospective review of the Maryland Health Services Cost Review Commission database from 2009 to 2013 was performed. The American Association for the Surgery of Trauma EGS ICD-9 codes were used to identify EGS patients. Data collected included demographics, TC designation, emergency department admissions, and All Patients Refined Severity of Illness (APR_SOI). Trauma center designation was used as a marker of a formal acute care surgery program. Primary outcomes included in-hospital mortality. Multivariable logistic regression analysis was performed controlling for age. There were 817,942 EGS encounters. Mean ± SD age of patients was 60.1 ± 18.7 years, 46.5% were males; 71.1% of encounters were at NTCs; and 75.8% were emergency department admissions. Overall mortality was 4.05%. Mortality was calculated based on TC designation controlling for age across APR_SOI strata. Multivariable logistic regression analysis did not show statistically significant differences in mortality between hospital levels for minor APR_SOI. For moderate APR_SOI, mortality was significantly lower for TCs compared with NTCs (p surgery patients treated at TCs had lower mortality for moderate APR_SOI, but increased mortality for extreme APR_SOI when compared with NTCs. Additional investigation is required to better evaluate this unexpected finding. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Increased ICU resource needs for an academic emergency general surgery service*.

    Science.gov (United States)

    Lissauer, Matthew E; Galvagno, Samuel M; Rock, Peter; Narayan, Mayur; Shah, Paulesh; Spencer, Heather; Hong, Caron; Diaz, Jose J

    2014-04-01

    ICU needs of nontrauma emergency general surgery patients are poorly described. This study was designed to compare ICU utilization of emergency general surgery patients admitted to an acute care emergency surgery service with other general surgery patients. Our hypothesis is that tertiary care emergency general surgery patients utilize more ICU resources than other general surgical patients. Retrospective database review. Academic, tertiary care, nontrauma surgical ICU. All patients admitted to the surgical ICU over age 18 between March 2004 and June 2012. None. Six thousand ninety-eight patients were evaluated: 1,053 acute care emergency surgery, 1,964 general surgery, 1,491 transplant surgery, 995 facial surgery/otolaryngology, and 595 neurosurgery. Acute care emergency surgery patients had statistically significantly longer ICU lengths of stay than other groups: acute care emergency surgery (13.5 ± 17.4 d) versus general surgery (8.7 ± 12.9), transplant (7.8 ± 11.6), oral-maxillofacial surgery (5.5 ± 4.2), and neurosurgery (4.47 ± 9.8) (all psurgery patients: acute care emergency surgery 73.4% versus general surgery 64.9%, transplant 63.3%, oral-maxillofacial surgery 58.4%, and neurosurgery 53.1% (all p surgery patients: acute care emergency surgery 10.8% versus general surgery 4.3%, transplant 6.6%, oral-maxillofacial surgery 0%, and neurosurgery 0.5% (all p surgery patients were more likely interhospital transfers for tertiary care services than general surgery or transplant (24.5% vs 15.5% and 8.3% respectively, p surgery (13.7% vs 6.7% and 3.5%, all p surgery and general surgery, whereas transplant had fewer. Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs

  10. Emergency surgery pre-operative delays - realities and economic impacts.

    Science.gov (United States)

    O'Leary, D P; Beecher, S; McLaughlin, R

    2014-12-01

    A key principle of acute surgical service provision is the establishment of a distinct patient flow process and an emergency theatre. Time-to-theatre (TTT) is a key performance indicator of theatre efficiency. The combined impacts of an aging population, increasing demands and complexity associated with centralisation of emergency and oncology services has placed pressure on emergency theatre access. We examined our institution's experience with running a designated emergency theatre for acute surgical patients. A retrospective review of an electronic prospectively maintained database was performed between 1/1/12 and 31/12/13. A cost analysis was conducted to assess the economic impact of delayed TTT, with every 24hr delay incurring the cost of an additional overnight bed. Delays and the economic effects were assessed only after the first 24 h as an in-patient had elapsed. In total, 7041 procedures were performed. Overall mean TTT was 26 h, 2 min. There were significant differences between different age groups, with those aged under 16 year and over 65 having mean TTT at 6 h, 34 min (95% C.I. 0.51-2.15, p 65 years age group had a mean TTT of 23 h, 41 min which was significantly longer than the overall mean TTT Vascular and urological emergencies are significantly disadvantaged in competition with other services for a shared emergency theatre. The economic impact of delayed TTT was calculated at €7,116,000, or €9880/day of additional costs generated from delayed TTT over a 24 month period. One third of patients waited longer than 24 h for emergency surgery, with the elderly disproportionately represented in this group. Aside from the clinical risks of delayed and out of hours surgery, such practices incur significant additional costs. New strategies must be devised to ensure efficient access to emergency theatres, investment in such services is likely to be financially and clinically beneficial. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier

  11. Diagnostic Accuracy of Detecting Hashimoto's Thyroiditis in Thyroid Cancer Patients Who Underwent Thyroid Surgery: Comparison of Ultrasonography, Positron Emission Tomography/CT, Contrast Enhanced CT, and Anti-Thyroid Antibody

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    Kim, Young Gyun; Lee, Tae Hyun; Park, Dong Hee; Nam, Sang Been [Dept. of Radiology, Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    2012-11-15

    To compare the diagnostic accuracy of ultrasonography (US), F18-fluorodeoxyglucose positron emission tomography/CT (PET/CT), contrast enhanced CT (CECT), serum anti-thyroid antibody for detecting Hashimoto's thyroiditis in thyroid cancer patients who underwent neck surgery. A total of 150 patients with suspicious for thyroid cancer, who had previously undergone US guided needle aspiration of thyroid, were evaluated with the use of US, PET/CT, CECT and serum anti-thyroid antibody. The four studies were performed within two months before neck surgery. Hashimoto's thyroiditis was confirmed by histopathological results. The diagnostic accuracy of US, PET/CT, CECT and serum anti-thyroid antibody were calculated statistically. Hashimoto's thyroiditis was diagnosed in 51 out of the 150 patients, following neck surgery. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US were 76.5%, 92.9%, 84.8%, 88.5%, and 87.3%, respectively. The corresponding values of PET/CT were 37.3%, 96.0%, 82.6%, 74.8%, and 76.0%, and CECT were 62.7%, 89.9%, 76.2%, 82.4%, and 80.7%, and serum anti-thyroid antibody level were 90.2%, 93.9%, 88.5%, 94.9%, and 92.7%, respectively. McNemar test revealed significant difference among PET/CT and others, but no significant differences among US, CECT and serum anti-thyroid antibody. Overall, serum anti-thyroid antibody showed most accurate diagnostic performance. In detecting Hashimoto's thyroiditis, serum anti-thyroid antibody showed higher diagnostic accuracy than others. US also showed relatively high diagnostic accuracy.

  12. Diagnostic Accuracy of Detecting Hashimoto's Thyroiditis in Thyroid Cancer Patients Who Underwent Thyroid Surgery: Comparison of Ultrasonography, Positron Emission Tomography/CT, Contrast Enhanced CT, and Anti-Thyroid Antibody

    International Nuclear Information System (INIS)

    Kim, Young Gyun; Lee, Tae Hyun; Park, Dong Hee; Nam, Sang Been

    2012-01-01

    To compare the diagnostic accuracy of ultrasonography (US), F18-fluorodeoxyglucose positron emission tomography/CT (PET/CT), contrast enhanced CT (CECT), serum anti-thyroid antibody for detecting Hashimoto's thyroiditis in thyroid cancer patients who underwent neck surgery. A total of 150 patients with suspicious for thyroid cancer, who had previously undergone US guided needle aspiration of thyroid, were evaluated with the use of US, PET/CT, CECT and serum anti-thyroid antibody. The four studies were performed within two months before neck surgery. Hashimoto's thyroiditis was confirmed by histopathological results. The diagnostic accuracy of US, PET/CT, CECT and serum anti-thyroid antibody were calculated statistically. Hashimoto's thyroiditis was diagnosed in 51 out of the 150 patients, following neck surgery. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US were 76.5%, 92.9%, 84.8%, 88.5%, and 87.3%, respectively. The corresponding values of PET/CT were 37.3%, 96.0%, 82.6%, 74.8%, and 76.0%, and CECT were 62.7%, 89.9%, 76.2%, 82.4%, and 80.7%, and serum anti-thyroid antibody level were 90.2%, 93.9%, 88.5%, 94.9%, and 92.7%, respectively. McNemar test revealed significant difference among PET/CT and others, but no significant differences among US, CECT and serum anti-thyroid antibody. Overall, serum anti-thyroid antibody showed most accurate diagnostic performance. In detecting Hashimoto's thyroiditis, serum anti-thyroid antibody showed higher diagnostic accuracy than others. US also showed relatively high diagnostic accuracy.

  13. Management of novel oral anticoagulants in emergency and trauma surgery.

    Science.gov (United States)

    Pinho-Gomes, Ana-Catarina; Hague, Adam; Ghosh, Jonathan

    2016-08-01

    The compelling safety, efficacy and predictable effect of novel oral anticoagulants (NOACs) is driving a rapid expansion in their therapeutic indications. Management of the increasing number of patients on those new agents in the setting of emergency or trauma surgery can be challenging and the absence of specific reversal agents has been a matter of concern. This review summarises the key principles that underpin the management of those patients with a particular emphasis on the recent development of specific antidotes. As of 2015, a new line of antidotes, specific for these drugs, are at different stages of their development with their release imminent. However, as NOACs are innately reversible due to their short half-life, the use of reversal agents will probably be restricted to a few exceptional cases. Post-marketing surveillance will be paramount to better clarify the role of these promising drugs. Management of patients on NOACs in the context of emergency or trauma surgery relies on best supportive care in combination with the blood products and/or specific antidotes as required. Familiarity with the new reversal agents is essential but further evidence on their indications, safety and efficacy as well as consensus guidelines are warranted prior to widespread adoption. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  14. Emergency surgery on mentally impaired patients: standard in consenting

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    Mihai Paduraru

    2018-04-01

    Full Text Available Emergency surgery is often performed on the elderly and susceptible patients with significant comorbidities; as a consequence, the risk of death or severe complications are high. Consent for surgery is a fundamental part of medical practice, in line with legal obligations and ethical principles. Obtaining consent for emergency services (for surgical patients with chronic or acute mental incapacity, due to surgical pathology is particularly challenging, and meeting the standards requires an up-to-date understanding of legislation, professional body guidelines, and ethical or cultural aspects. The guidance related to consent requires physicians and other medical staff to work with patients according to the process of ‘supported decision-making’. Despite principles and guidelines that have been exhaustively established, the system is sometimes vulnerable in actual clinical practice. The combination of an ‘emergency’ setting and a patient without mental ‘capacity’ is a challenge between patient-centered and ‘paternalistic’ approaches, involving legislation and guidelines on ‘best interests’ of the patient.

  15. Management of Complications Following Emergency and Elective Surgery for Diverticulitis.

    Science.gov (United States)

    Holmer, Christoph; Kreis, Martin E

    2015-04-01

    The clinical spectrum of sigmoid diverticulitis (SD) varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications. Sigmoid colectomy with restoration of continuity has been the prevailing modality for treating acute and recurrent SD, and is often performed as a laparoscopy-assisted procedure. For elective sigmoid colectomy, the postoperative morbidity rate is 15-20% whereas morbidity rates reach up to 30% in patients who undergo emergency surgery for perforated SD. Some of the more common and serious surgical complications after sigmoid colectomy are anastomotic leaks and peritonitis, wound infections, small bowel obstruction, postoperative bleeding, and injuries to the urinary tract structures. Regarding the management of complications, it makes no difference whether the complication is a result of an emergency or an elective procedure. The present work gives an overview of the management of complications in the surgical treatment of SD based on the current literature. To achieve successful management, early diagnosis is mandatory in cases of deviation from the normal postoperative course. If diagnostic procedures fail to deliver a correlate for the clinical situation of the patient, re-laparotomy or re-laparoscopy still remain among the most important diagnostic and/or therapeutic principles in visceral surgery when a patient's clinical status deteriorates. The ability to recognize and successfully manage complications is a crucial part of the surgical treatment of diverticular disease and should be mastered by any surgeon qualified in this field.

  16. Frailty as a predictor of mortality in the elderly emergency general surgery patient.

    Science.gov (United States)

    Goeteyn, Jens; Evans, Louis A; De Cleyn, Siem; Fauconnier, Sigrid; Damen, Caroline; Hewitt, Jonathan; Ceelen, Wim

    2017-12-01

    The number of surgical procedures performed in elderly and frail patients has greatly increased in the last decades. However, there is little research in the elderly emergency general surgery patient. The aim of this study was to assess the prevalence of frailty in the emergency general surgery population in Belgium. Secondly, we examined the length of hospital stay, readmission rate and mortality at 30 and 90 days. We conducted a prospective observational study at Ghent University Hospital. All patients older than 65 admitted to a general surgery ward from the emergency department were eligible for inclusion. Primary endpoint was mortality at 30 days. Secondary outcomes were mortality at 90 days, readmissions and length of stay. Cross-sectional observations were performed using the Fisher exact test, Mann-Whitney U-test, or one-way ANOVA. We performed a COX multivariable analysis to identify independent variables associated with mortality at 30 and 90 days as well as the readmission risk. Data were collected from 98 patients in a four-month period. 23.5% of patients were deemed frail. 79% of all patients underwent abdominal surgery. Univariate analyses showed that polypharmacy, multimorbidity, a history of falls, hearing impairment and urinary incontinence were statistically significantly different between the non-frail and the group. Frail patients showed a higher incidence for mortality within 30 days (9% versus 1.3% (p = .053)). There were no differences between the two groups for mortality at 90 days, readmission, length of stay and operation. Frailty was a predictor for mortality at 90 days (p= .025) (hazard ratio (HR) 10.83 (95%CI 1.34-87.4)). Operation (p= .084) (HR 0.16 (95%CI 0.16-1.29)) and the presence of chronic cardiac failure (p= .049) (HR 0.38 (95%CI 0.14-0.99)) were protective for mortality at 90 days. Frailty is a significant predictor for mortality for elderly patients undergoing emergency abdominal/general surgery. Level II therapeutic

  17. Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function

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    Sertel Serkan

    2011-09-01

    Full Text Available Abstract Background Surgery after (chemoradiation (RCTX/RTX is felt to be plagued with a high incidence of wound healing complications reported to be as high as 70%. The additional use of vascularized flaps may help to decrease this high rate of complications. Therefore, we examined within a retrospective single-institutional study the peri--and postoperative complications in patients who underwent surgery for salvage, palliation or functional rehabilitation after (chemoradiation with regional and free flaps. As a second study end point the Karnofsky performance status (KPS was determined preoperatively and 3 months postoperatively to assess the impact of such extensive procedures on the overall performance status of this heavily pretreated patient population. Findings 21 patients were treated between 2005 and 2010 in a single institution (17 male, 4 female for salvage (10/21, palliation (4/21, or functional rehabilitation (7/21. Overall 23 flaps were performed of which 8 were free flaps. Major recipient site complications were observed in only 4 pts. (19% (1 postoperative haemorrhage, 1 partial flap loss, 2 fistulas and major donor site complications in 1 pt (wound dehiscence. Also 2 minor donor site complications were observed. The overall complication rate was 33%. There was no free flap loss. Assessment of pre- and postoperative KPS revealed improvement in 13 out of 21 patients (62%. A decline of KPS was noted in only one patient. Conclusions We conclude that within this (chemoradiated patient population surgical interventions for salvage, palliation or improve function can be safely performed once vascularised grafts are used.

  18. Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer.

    Science.gov (United States)

    Kızıltan, Remzi; Yılmaz, Özkan; Aras, Abbas; Çelik, Sebahattin; Kotan, Çetin

    2016-02-01

    To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had undergone emergency surgery due to complicated colorectal cancer. A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department of General Surgery, Dursun Odabaş Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed. There were 14 (42.5%) male and 19 (57.5%) female patients. Mean age was 60 years (range: 32- 83 years); 14 (42.5%) patients were less than 60 years old , while 19 (57.5%) were 60 years old or older. Operations were performed due to perforation (39.3%) and obstruction (60.6%) in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2%) and in the left colon in 24 cases (72.7%). Eleven (33.3%) patients underwent resection and anastomosis, 13 (39.3%) resection and ostomy, and nine (27.2%) patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%). High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity rates. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

  19. Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer

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    Remzi Kızıltan

    2016-02-01

    Full Text Available Aim To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had undergone emergency surgery due to complicated colorectal cancer. Methods A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department of General Surgery, Dursun Odabaş Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed. Results There were 14 (42.5% male and 19 (57.5% female patients. Mean age was 60 years (range: 32- 83 years; 14 (42.5% patients were less than 60 years old , while 19 (57.5% were 60 years old or older. Operations were performed due to perforation (39.3% and obstruction (60.6% in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2% and in the left colon in 24 cases (72.7%. Eleven (33.3% patients underwent resection and anastomosis, 13 (39.3% resection and ostomy, and nine (27.2% patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%. Conclusions High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity rates.

  20. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery.

    Science.gov (United States)

    Rangel, Erika L; Rios-Diaz, Arturo J; Uyeda, Jennifer W; Castillo-Angeles, Manuel; Cooper, Zara; Olufajo, Olubode A; Salim, Ali; Sodickson, Aaron D

    2017-12-01

    Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is

  1. Venous Thromboembolism Prevention in Emergency General Surgery: A Review.

    Science.gov (United States)

    Murphy, Patrick B; Vogt, Kelly N; Lau, Brandyn D; Aboagye, Jonathan; Parry, Neil G; Streiff, Michael B; Haut, Elliott R

    2018-05-01

    Venous thromboembolism (VTE) is the most preventable cause of morbidity and mortality in US hospitals, and approximately 2.5% of emergency general surgery (EGS) patients will be diagnosed with a VTE event. Emergency general surgery patients are at increased risk of morbidity and mortality because of the nature of acute surgical conditions and the challenges related to prophylaxis. MEDLINE, Embase, and the Cochrane Database of Collected Reviews were searched from January 1, 1990, through December 31, 2015. Nearly all operatively and nonoperatively treated EGS patients have a moderate to high risk of developing a VTE, and individual risk should be assessed at admission. Pharmacologic prophylaxis in the form of unfractionated or low-molecular-weight heparin should be considered unless an absolute contraindication, such as bleeding, exists. Patients should receive the first dose at admission to the hospital, and administration should continue until discharge without missed doses. Certain patient populations, such as those with malignant tumors, may benefit from prolonged VTE prophylaxis after discharge. Mechanical prophylaxis should be considered in all patients, particularly if pharmacologic prophylaxis is contraindicated. Studies that specifically target improved adherence with VTE prophylaxis in EGS patients suggest that efficacy and quality improvement initiatives should be undertaken from a system and institutional perspective. Operatively and nonoperatively treated EGS patients are at a comparatively high risk of VTE. Despite gaps in existing literature with respect to this increasing patient population, successful best practices can be applied. Best practices include assessment of VTE risk, optimal prophylaxis, and physician, nurse, and patient education regarding the use of mechanical and pharmacologic VTE prophylaxis and institutional policies.

  2. Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland

    NARCIS (Netherlands)

    Sugrue, M.; Maier, R.; Moore, E. E.; Boermeester, M.; Catena, F.; Coccolini, F.; Leppaniemi, A.; Peitzman, A.; Velmahos, G.; Ansaloni, L.; Abu-Zidan, F.; Balfe, P.; Bendinelli, C.; Biffl, W.; Bowyer, M.; DeMoya, M.; de Waele, J.; di Saverio, S.; Drake, A.; Fraga, G. P.; Hallal, A.; Henry, C.; Hodgetts, T.; Hsee, L.; Huddart, S.; Kirkpatrick, A. W.; Kluger, Y.; Lawler, L.; Malangoni, M. A.; Malbrain, M.; MacMahon, P.; Mealy, K.; O'Kane, M.; Loughlin, P.; Paduraru, M.; Pearce, L.; Pereira, B. M.; Priyantha, A.; Sartelli, M.; Soreide, K.; Steele, C.; Thomas, S.; Vincent, J. L.; Woods, L.

    2017-01-01

    Background: Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was

  3. General surgery 2.0: the emergence of acute care surgery in Canada

    Science.gov (United States)

    Hameed, S. Morad; Brenneman, Frederick D.; Ball, Chad G.; Pagliarello, Joe; Razek, Tarek; Parry, Neil; Widder, Sandy; Minor, Sam; Buczkowski, Andrzej; MacPherson, Cailan; Johner, Amanda; Jenkin, Dan; Wood, Leanne; McLoughlin, Karen; Anderson, Ian; Davey, Doug; Zabolotny, Brent; Saadia, Roger; Bracken, John; Nathens, Avery; Ahmed, Najma; Panton, Ormond; Warnock, Garth L.

    2010-01-01

    Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery. The ACS model also offers enhanced opportunities for surgical education for students, residents and practicing surgeons, and it will provide avenues to strengthen clinical and academic bonds between the community and academic surgical centres. In the near future, cooperation of ACS services from community and academic hospitals across the country will lead to the formation of systems of acute surgical care whose development will be informed by rigorous data collection and research and evidence-based quality-improvement initiatives. In an era of increasing subspecialization, ACS is a strong unifying force in general surgery and a platform for collective advocacy for an important patient population. PMID:20334738

  4. Epidemiological approach to emergent cranial surgery of cranial traumas

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    Hülagü Kaptan

    2008-03-01

    Full Text Available

    Objective: In this study, we aim to define the emergent cranial surgery of cranial trauma cases in terms of the reason of occurance, diagnosis, prognostic factors and results. Methods: 153 cases hospitalized in our clinic during a four year period were statistically analysed in accordance with trauma etiology, age, gender, application GCS (Glascow Coma Score mortality rate, location and established patology.

    Results: 76% (116 of the 153 cases were male. The most frequent etiological reasons were, in descending order, traffic accident 52% (n = 80, fall 34% (n = 53, direct trauma to the head 14(n =20. 45% (n = 69 were diagnosed epidural haematomas, 26% (n = 40 were diagnosed depression fractures and 3% (n = 5 were diagnosed intracerebral haematomas. A meaningful statistical difference was found in the comparison of the diagnosis regarding gender (p=0,012 age group (p=0,0282 and GCS (p=0,0001.

    Conclusions: In order to prevent cranial traumas, studies aimed at minimizing traffic accidents should be undertaken. The most essential action after the accident has occured is triage, and this is of great importance in order to establish communication among the health institutions.

  5. Encountering Meckel's diverticulum in emergency surgery for ascaridial intestinal obstruction

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    Amin Abid

    2010-06-01

    Full Text Available Abstract Background Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In children with intestinal ascariasis, the diverticulum remains asymptomatic or rarely the Ascaris lumbricoides may lead to its complications in the presence of massive intestinal roundworm load. Given that preoperative diagnosis is seldom carried out, when Meckel's diverticulum is found at laparotomy for obstructive intestinal complications of roundworm, the diverticulum should be removed as complications may occur at any time. The aim of this study was to describe the findings of concomitant presence of Meckel's diverticulum who had surgical intervention in symptomatic intestinal ascariasis in children. Methods A retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckel's diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir. Results A total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckel's diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckel's diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction. Conclusion Meckel's diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckel's diverticulum in the intestinal ascariasis should have removal.

  6. Current status and future options for trauma and emergency surgery in Turkey.

    Science.gov (United States)

    Taviloğlu, Korhan; Ertekin, Cemalettin

    2008-01-01

    The number of trauma victims in Turkey is expected to increase as a consequence of the increasing vehicular traffic, potential for earthquakes, and risk of terrorist attacks. The Turkish Association for Trauma and Emergency Surgery monitors trauma cases, publishes a quarterly journal, organizes trauma courses and seminars for various health personnel nationwide. It is also extending efforts to improve in-hospital care by establishing trauma and emergency surgery fellowships and trauma and emergency surgery centers nationwide, which is run by General Surgeons currently. Turkey faces the same dilemma as the rest of the developed world regarding the future of trauma surgeons in the current era of nonoperative trauma management. We suggest that the field of trauma and emergency surgery be redefined to include emergency general surgery and cavitary trauma.

  7. Are You Ready for Emergency Medical Services in Your Oral and Maxillofacial Surgery Office?

    Science.gov (United States)

    Rayner, Clive; Ragan, Michael R

    2018-05-01

    Efficient responses to emergencies in the oral and maxillofacial surgery office require preparation, communication, and thorough documentation of the event and response. The concept of team anesthesia is showcased with these efforts. Emergency medical services training and response times vary greatly. The oral and maxillofacial surgery office should be prepared to manage the patient for at least 15 minutes after making the call to 911. Patient outcomes are optimized when providers work together to manage and transport the patient. Oral and maxillofacial surgery offices should develop and rehearse emergency plans and coordinate these protocols with local Emergency medical services teams. Copyright © 2018 Elsevier Inc. All rights reserved.

  8. Emergency surgery for complicated colorectal cancer in central Brazil

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    Alex Caetano dos Santos

    2014-04-01

    Full Text Available Objective: to report clinical and pathological features of patients with colorectal cancer diagnosed during emergency abdominal surgery. Methods: records of 107 patients operated between 2006 and 2010 were reviewed. Results: there were 58 women and 49 men with mean age of 59.8 years. The most frequent symptoms were: abdominal pain (97.2%, no bowel movements (81.3%, vomiting (76.6%, and anorexia (40.2%. Patients were divided into five groups: obstructive acute abdomen (n = 68, obstructive acute perforation (n = 21, obstructive acute inflammation (n = 13, abdominal sepsis (n = 3, and severe gastrointestinal bleeding (n = 2. Tumors were located in the rectosigmoid (51.4%, transverse colon (19.6%, ascendent colon (12.1%, descendent colon (11.2%, and 5.6% of the cases presented association of two colon tumors (synchronic tumors. The surgical treatment was: tumor resection with colostomy (85%, tumor resection with primary anastomosis (10.3%, and colostomy without tumor resection (4.7%. Immediate mortality occurred in 33.4% of the patients. Bivariate analysis of sex, tumor location and stage showed no relation to death (p > 0.05%. Conclusions: colorectal cancer may be the cause of colon obstruction or perfuration in patients with nonspecific colonic complaints. Despite the high mortality rate, resection of tumor is feasible in most patients. Resumo: Objetivo: analisar os aspectos clinicos e patológicos de pacientes operados de cancer colorretal diagnosticados durante operações abdominais de urgencia. Métodos: foram estudados os prontuários de 107 pacientes operados entre 2006 e 2010. Resultados: Foram incluidos 58 mulheres e 49 homens com idade media de 59,8 anos. Os sintomas mais frequentes foram: dor abdominal (97,2%, parade de eliminação de gases e fezes (81,3%, vomitos (76,6% e anorexia (40,2%. Os pacientes foram divididos em cinco grupos: abdomen agudo obstrutivo (68, abdomen agudo perfurativo (21, abdomen agudo inflamatorio (13

  9. 30-Day, 90-day and 1-year mortality after emergency colonic surgery

    DEFF Research Database (Denmark)

    Pedersen, T; Watt, S K; Tolstrup, M-B

    2017-01-01

    PURPOSE: Emergency surgery is an independent risk factor in colonic surgery resulting in high 30-day mortality. The primary aim of this study was to report 30-day, 90-day and 1-year mortality rates after emergency colonic surgery, and to report factors associated with 30-day, 90-day and 1-year...... mortality. Second, the aim was to report 30-day postoperative complications and their relation to in-hospital mortality. METHODS: All patients undergoing acute colonic surgery in the period from May 2009 to April 2013 at Copenhagen University Hospital Herlev, Denmark, were identified. Perioperative data...... postoperative deaths. CONCLUSION: Mortality and complication rates after emergency colonic surgery are high and associated with patient related risk factors that cannot be modified, but also treatment related outcomes that are modifiable. An increased focus on medical and other preventive measures should...

  10. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how patie......, intermediate care patients felt hindered in doing so by continuous monitoring of vital signs. RELEVANCE TO CLINICAL PRACTICE: Intermediate care may increase patient perceptions of quality and safety of care.......AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating...

  11. Comparison of maintenance, emergence and recovery characteristics of sevoflurane and desflurane in pediatric ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Manish B Kotwani

    2017-01-01

    Conclusion: Desflurane provides faster emergence and recovery in comparison to sevoflurane when used for the maintenance of anesthesia through SGA in children. Both sevoflurane and desflurane can be safely used in children for lower abdominal surgeries.

  12. Laparoscopy in major abdominal emergency surgery seems to be a safe procedure

    DEFF Research Database (Denmark)

    Nielsen, Liv Bjerre Juul; Tengberg, Line Toft; Bay-Nielsen, Morten

    2017-01-01

    INTRODUCTION: Laparoscopy is well established in the majority of elective procedures in abdominal surgery. In contrast, it is primarily used in minor surgery such as appendectomy or cholecystectomy in the emergent setting. This study aimed to analyze the safety and effectiveness of a laparoscopic...

  13. FREE ANTEROLATERAL FEMORAL FLAP IS THE FIRST CHOICE IN EMERGENCY RECONSTRUCTIVE SURGERY OF THE LOWER LIMB (ANALYSIS OF CLINICAL CASES

    Directory of Open Access Journals (Sweden)

    A. V. Nevedrov

    2015-01-01

    Full Text Available BACKGROUND. Requirements for the graft used in microsurgery are simple retrieval, minimal anatomic variability, the possibility to operate on one surgical area, great length and diameter of flap vessels.PURPOSE OF STUDY. Evaluation of the results and advantages of revascularized free anterolateral muscle flap usage in emergency surgery.MATERIALS AND METHODS. Free muscle flap of the lateral vastus muscle on a vascular pedicle of the descending branch of the lateral femoral circumflex artery (anterolateral flap was used to replace the defect in 2 patients. In one case, a patient had open fractures of the lower leg, complicated with primary defects of soft tissue, and in the other case a patient had incomplete traumatic amputation of the left foot. All the victims underwent soft tissue defects restoration within the first hours after the injury, next to fixation of the fracture.RESULTS. All grafts have completely healed, total necrosis of muscle flaps hasn’t been observed. All patients had primary wound healing after the transfer. Cases of deep purulent infection after the surgery haven’t been noted.CONCLUSION. The transfer of a free anterolateral muscle flap is the best method for emergency plastic and reconstructive surgery of the lower limbs. The advantages are simple and prompt retreival, no need to turn the patient to the lateral position, large amount of the flap, great length and caliber of vessels. 

  14. Navigation in head and neck oncological surgery: an emerging concept.

    Science.gov (United States)

    Gangloff, P; Mastronicola, R; Cortese, S; Phulpin, B; Sergeant, C; Guillemin, F; Eluecque, H; Perrot, C; Dolivet, G

    2011-01-01

    Navigation surgery, initially applied in rhinology, neurosurgery and orthopaedic cases, has been developed over the last twenty years. Surgery based on computed tomography data has become increasingly important in the head and neck region. The technique for hardware fusion between RMI and computed tomography is also becoming more useful. We use such device since 2006 in head and neck carcinologic situation. Navigation allows control of the resection in order to avoid and protect the precise anatomical structures (vessels and nerves). It also guides biopsy and radiofrequency. Therefore, quality of life is much more increased and morbidity is decreased for these patients who undergo major and mutilating head and neck surgery. Here we report the results of 33 navigation procedures performed for 31 patients in our institution.

  15. Mortality following emergency groin hernia surgery in Denmark

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper; Bay-Nielsen, M; Kehlet, H

    2010-01-01

    The mortality following emergency groin hernia repair in Denmark is more than twice as high (7%) as in comparable countries. This article describes in detail the population that died following emergency herniotomy in order to identify aspects of care that may improve outcome.......The mortality following emergency groin hernia repair in Denmark is more than twice as high (7%) as in comparable countries. This article describes in detail the population that died following emergency herniotomy in order to identify aspects of care that may improve outcome....

  16. Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score

    DEFF Research Database (Denmark)

    Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten

    2016-01-01

    BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has nev...... emergency high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting....

  17. Emergency abdominal surgery in Zaria, Nigeria | Ahmed | South ...

    African Journals Online (AJOL)

    Background. The causes of abdominal surgical emergencies in a particular setting may change because of alterations in demographic, socio-economic or geographical factors. We present the pattern, management and outcome of such emergencies in Zaria, Northern Nigeria. Methods. This is a retrospective review of ...

  18. Logistics and outcome in urgent and emergency colorectal surgery

    DEFF Research Database (Denmark)

    Elshove-Bolk, J.; Ellensen, V. S.; Baatrup, G.

    2010-01-01

    died were less likely to be operated by a subspecialized colorectal surgeon (17%. vs 30%, P = 0.001). The anaesthesiologist was a resident in most of the cases (> 75%) for both those who survived and those who died. Surgery performed out-of-office hours was common in both groups, although the patients...

  19. Complications of bariatric surgery: Presentation and emergency management.

    Science.gov (United States)

    Kassir, Radwan; Debs, Tarek; Blanc, Pierre; Gugenheim, Jean; Ben Amor, Imed; Boutet, Claire; Tiffet, Olivier

    2016-03-01

    The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  20. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial

    DEFF Research Database (Denmark)

    Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn

    2013-01-01

    ABSTRACT: BACKGROUND: Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality....... The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency...... laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure...

  1. Emerging Applications of Bedside 3D Printing in Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Michael P Chae

    2015-06-01

    Full Text Available Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D reconstructions, are limited by their representation on 2D workstations. 3D printing has been embraced by early adopters to produce medical imaging-guided 3D printed biomodels that facilitate various aspects of clinical practice. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. With increasing accessibility, investigators are now able to convert standard imaging data into Computer Aided Design (CAD files using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography (SLA, multijet modeling (MJM, selective laser sintering (SLS, binder jet technique (BJT, and fused deposition modeling (FDM. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without out-sourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. In this review the existing uses of 3D printing in plastic surgery practice, spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative aesthetics, are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, patient and surgical trainee education, and the development of intraoperative guidance tools and patient-specific prosthetics in everyday surgical practice.

  2. Emerging Applications of Bedside 3D Printing in Plastic Surgery.

    Science.gov (United States)

    Chae, Michael P; Rozen, Warren M; McMenamin, Paul G; Findlay, Michael W; Spychal, Robert T; Hunter-Smith, David J

    2015-01-01

    Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing

  3. Emerging Applications of Bedside 3D Printing in Plastic Surgery

    Science.gov (United States)

    Chae, Michael P.; Rozen, Warren M.; McMenamin, Paul G.; Findlay, Michael W.; Spychal, Robert T.; Hunter-Smith, David J.

    2015-01-01

    Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing

  4. Emerging Applications of Bedside 3D Printing in Plastic Surgery

    OpenAIRE

    Chae, Michael P.; Rozen, Warren M.; McMenamin, Paul G.; Findlay, Michael W.; Spychal, Robert T.; Hunter-Smith, David J.

    2015-01-01

    Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embrac...

  5. A procalcitonin-based algorithm to guide antibiotic therapy in secondary peritonitis following emergency surgery: a prospective study with propensity score matching analysis.

    Science.gov (United States)

    Huang, Ting-Shuo; Huang, Shie-Shian; Shyu, Yu-Chiau; Lee, Chun-Hui; Jwo, Shyh-Chuan; Chen, Pei-Jer; Chen, Huang-Yang

    2014-01-01

    Procalcitonin (PCT)-based algorithms have been used to guide antibiotic therapy in several clinical settings. However, evidence supporting PCT-based algorithms for secondary peritonitis after emergency surgery is scanty. In this study, we aimed to investigate whether a PCT-based algorithm could safely reduce antibiotic exposure in this population. From April 2012 to March 2013, patients that had secondary peritonitis diagnosed at the emergency department and underwent emergency surgery were screened for eligibility. PCT levels were obtained pre-operatively, on post-operative days 1, 3, 5, and 7, and on subsequent days if needed. Antibiotics were discontinued if PCT was Advanced age, coexisting pulmonary diseases, and higher severity of illness were significantly associated with longer durations of antibiotic use. The PCT-based algorithm safely reduces antibiotic exposure in this study. Further randomized trials are needed to confirm our findings and incorporate cost-effectiveness analysis. Australian New Zealand Clinical Trials Registry ACTRN12612000601831.

  6. Improving time to surgery for hip fracture patients. Impact of the introduction of an emergency theatre

    LENUS (Irish Health Repository)

    French-O’Carroll, F

    2017-01-01

    Hip fractures are a major cause of morbidity and mortality1. Surgery performed on the day of or after admission is associated with improved outcome2,3. An audit cycle was performed examining time to surgery for hip fracture patients. Our initial audit identified lack of theatre space as one factor delaying surgery. A dedicated daytime emergency theatre was subsequently opened and a re-audit was performed to assess its impact on time to surgery. Following the opening of the theatre, the proportion of patients with a delay to hip fracture surgery greater than 36 hours was reduced from 49% to 26% with lack of theatre space accounting for 23% (3 of 13) of delayed cases versus 28.6% (9 of 32) previously. 44% of hip fracture surgeries were performed in the emergency theatre during daytime hours, whilst in-hospital mortality rose from 4.6% to 6%. We conclude that access to an emergency theatre during daytime hours reduced inappropriate delays to hip fracture surgery.

  7. Dexmedetomidine does not reduce emergence agitation in adults following orthognathic surgery.

    Science.gov (United States)

    Ham, S Y; Kim, J E; Park, C; Shin, M J; Shim, Y H

    2014-09-01

    Patients undergoing orthognathic surgery are at high risk of developing emergence agitation. We hypothesised that a single-dose of dexmedetomidine would reduce emergence agitation in adults with nasotracheal intubation after orthognathic surgery. Seventy adults (20-45 years old) undergoing orthognathic surgery were randomly assigned to two groups. Patients received intravenous dexmedetomidine 1 μg/kg (dex group) or normal saline (control group) for 10 min at the end of surgery. Remifentanil was infused at 0.02 μg/kg/min during emergence in both groups. The severity of emergence agitation was assessed with the Richmond agitation-sedation scale. Cough, haemodynamic and respiratory profiles, pain, and time to eye opening were evaluated. The incidence of emergence agitation was not different between dex group and control group (38% vs. 47%, P = 0.45). However, severe cough during emergence was reduced in the dex group (P = 0.04). Tachycardia during emergence and recovery phases was attenuated in the dex group. The verbal numeric rating of pain was lower in the dex group. There were no differences in respiratory rate between the two groups. Time to eye opening was prolonged in the dex group. The addition of a single dose of dexmedetomidine (1 μg/kg) to low-dose remifentanil infusion did not attenuate emergence agitation in intubated patients after orthognathic surgery compared with low-dose remifentanil infusion alone. However, single-dose dexmedetomidine suppressed coughing, haemodynamic changes, and pain during emergence and recovery phases, without respiratory depression. Delayed awakening might be associated with this treatment. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  8. Results of emergency surgery in patients with Moschowitz's disease refractory to hematological treatment: is splenectomy always advisable?

    Science.gov (United States)

    Caronna, R; Cardi, M; Meloni, G; Mangioni, S; Spera, G; Benedetti, M; Frantellizzi, V; Layek, D; Catinelli, S; Schiratti, M; Chirletti, P

    2005-01-01

    Patients with thrombotic thrombocytopenic purpura (TTP), Moschowitz's disease, run a high risk of perioperative bleeding and need intensive hematologic support. In some patients, TTP is associated with cancer but the surgical role in these patients is still unclear. To illustrate the surgical problems and outcome we present the case histories of three patients with TTP observed in our emergency department. Two patients had TTP secondary to cancer and one patient with primary TTP (no evidence of neoplasia) had emergency operation for gastric hemorrhage, occlusion and TTP unresponsive to plasmapheresis. The first two patients who had not radical resection of cancer and no splenectomy, died for TTP complications. The third patient who underwent emergency splenectomy, had an uneventful postoperative course and TTP completely regressed. These case reports suggest that patients with TTP should be screened to rule out cancer. In patients with acute cancer-related complications emergency surgery should aim to resect the cancer. An associated splenectomy may increase the effectiveness of postoperative hematologic therapy.

  9. Emergency surgery for lung cancer with abscess formation after transbronchial biopsy

    OpenAIRE

    Takanashi, Yusuke; Miyashita, Koichi; Tajima, Shogo; Hayakawa, Takamitsu; Neyatani, Hiroshi; Funai, Kazuhito

    2017-01-01

    Abscess formation in lung cancer after transbronchial biopsy (TBB) is a rare complication with no standard consensus on a coping strategy or prophylaxis. We describe an instructive case of lung cancer which developed into an abscess after TBB. An 80?year?old man with poorly controlled diabetes mellitus underwent TBB for diagnosing a mass lesion in the left upper lobe. The TBB specimen confirmed a diagnosis of lung cancer, and he was scheduled for radical surgery. However, the tumour was revea...

  10. The emergence of radiofrequency identification tags: applications in surgery.

    Science.gov (United States)

    Schwaitzberg, S D

    2006-08-01

    Radiofrequency identification (RFID) is a wireless method of automatic identification. Currently, RFID tags are emerging into our environment in many aspects of our lives. Applications are being developed in a variety of fields, including health care. Aspects of surgical care will lend themselves to this approach. This technology could provide large amounts of data that not only carry the promise of improving health care, but also may have an impact on personal aspects of our daily lives. Each of us must become familiar with the risks and benefits of RFID use.

  11. Increased mortality in the elderly after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Svenningsen, Peter; Manoharan, Thukirtha; Foss, Nicolai B

    2014-01-01

    was a retrospective analysis of patient charts and perioperative documentation in an unselected consecutive cohort of 131 patients. Covariates for survival outcomes were evaluated in a multivariate analysis. No external funding and no competing interests were declared. The study was approved by The Danish Data...... within 30 days post-operatively. CONCLUSION: Acute admission and emergency laparotomy is associated with a very high mortality, especially in elderly patients. However, delay in the surgical treatment exceeding six hours is not associated with a higher mortality. There may be a considerable potential...

  12. Increased risk environment for emergency general surgery in the context of regionalization and specialization.

    Science.gov (United States)

    Beecher, S; O'Leary, D P; McLaughlin, R

    2015-09-01

    The pressures on tertiary hospitals with increased volume and complexity related to regionalization and specialization has impacted upon availability of operating theatres with consequent displacement of emergencies to high risk out of hours settings. A retrospective review of an electronic emergency theatre list prospectively maintained database was performed over a two year period. Data gathered included type of operation performed, Time to Theatre (TTT), operation start time and length of stay (LOS). Of 7041 emergency operations 25% were performed out of hours. 2949 patient had general surgical emergency procedures with 910 (30%) performed out of hours. 53% of all emergency laparotomies and 54% of appendicectomies were out of hours. 57% of cases operated on out of hours had been awaiting surgery during the day. Mean TTT was shorter for those admitted at the weekend compared to those admitted during the week (15.6 vs 24.9 h) (p emergency surgery is performed out of hours in a way unfavorable to good clinical outcomes. It is of concern that more than half of the most life threating procedures involving laparotomy, take place out of hours. Regionalization needs to be accompanied by infrastructure planning to accommodate emergency surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  13. Geographic Diffusion and Implementation of Acute Care Surgery: An Uneven Solution to the National Emergency General Surgery Crisis.

    Science.gov (United States)

    Khubchandani, Jasmine A; Ingraham, Angela M; Daniel, Vijaya T; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

    2018-02-01

    Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging. A national survey on EGS practices was developed, tested, and administered at all 2811 US acute care hospitals providing EGS to adults between August 2015 and October 2015. Surgeons responsible for EGS coverage at these hospitals were approached. If these surgeons failed to respond to the initial survey implementation, secondary surgeons or chief medical officers at hospitals with only 1 general surgeon were approached. Survey responses on ACS implementation were linked with geocoded hospital data and national census data to determine geographic diffusion of and access to ACS. We measured the distribution of hospitals with ACS models of care vs those without over time (diffusion) and by US counties characterized by sociodemographic characteristics of county residents (access). Survey response rate was 60% (n = 1690); 272 responding hospitals had implemented ACS by 2015, steadily increasing from 34 in 2001 to 125 in 2010. Acute care surgery implementation has not been uniform. Rural regions have limited ACS access, with hospitals in counties with greater than the 75th percentile population having 5.4 times higher odds (95% CI, 1.66-7.35) of implementing ACS than hospitals in counties with less than 25th percentile population. Communities with greater percentages of adults without a college degree also have limited ACS access (OR, 3.43; 95% CI, 1.81-6.48). However, incorporating EGS into ACS models may be a potential equalizer for poor, black, and Hispanic communities. Understanding and

  14. Use of a Combination of Regional and General Anesthesia during Emergency Thoracic Surgery

    Directory of Open Access Journals (Sweden)

    V. Kh. Sharipova

    2015-01-01

    Full Text Available Objective: to elaborate multimodal anesthetic regimens and to evaluate their efficiency during emergency thoracic surgeries for varying injuries. Subjects and methods. A total of 116 patients emergently admitted to the Republican Research Center for Emergency Medical Care for chest traumatic injuries were examined and divided into 3 groups according to the mode of anesthesia. Results. Perioperative multimodal anesthetic regimens for emergency thoracic surgery, which involved all components of the pathogenesis of pain, were elaborated. Conclusion. The combination of regional and general anesthesia contributes to the smooth course of an intra operative period with minimal hemodynamic stress and it is cost effective in decreasing the use of narcotic anal gesics in the intraoperative period. 

  15. Outcome of burr hole surgery in the emergency room for severe acute subdural hematoma

    International Nuclear Information System (INIS)

    Park, Young-Soo; Hironaka, Yasuhiro; Motoyama, Yasushi; Asai, Hideki; Watanabe, Tomoo; Nishio, Kenji; Nakase, Hiroyuki; Okuchi, Kazuo

    2010-01-01

    We have performed burr hole surgery in the emergency room for severe acute subdural hematoma from April 2007 in twenty five patients. All patients were deep comatose and showed cerebral herniation sign with bilateral pupillary abnormalities. Burr hole surgeries were performed as soon as possible after CT evaluation. Continually decomporresive craiectomies were followed if clinical improvements were achieved and mild baribiturate-moderate hypothermia combined (MB-MH) therapy was induced postoperatively in some cases. The mean average was 65.6 years (range 16-93). The causes of head injuries were traffic accident in 9, fall down in 13 and unknown in 3. The mean Glasgow coma scale (GCS) on admission was 4.4 (range 3-9). The mean time interval from arrival to burr hole surgery was 33.5 minutes (range 21-50 minutes). Decompressive craniectomy was indicated in 14 cases and MB-MH therapy was induced in 13 cases. The overall clinical outcome consisted of good recovery in 3, moderate disability in 2, severe disability in 3, persistent vegetative state in 3 and death in 14. Favorable results can be expected even in patients with serious acute subdural hematoma. Emergent burr hole surgery was effective to decrease intracranial pressure rapidly and to save time. So active burr hole surgery in the emergency room is strongly recommended to all cases of severe acute subdural hematoma. (author)

  16. Consequências da vasectomia: experiência de homens que se submeteram à cirurgia em Campinas (São Paulo, Brasil Consequences of vasectomy: experience of men who underwent the surgery in Campinas (São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Nádia Maria Marchi

    2011-09-01

    qualitative stage, 10 semi-structured interviews were performed with men selected according to purposeful criteria of level of schooling and number of children. Then, a structured form was provided for 202 men, drawn from the complete list of those who had had a vasectomy between 1998 and 2004. A thematic analysis of the content of the semi-structured interviews was carried out. The quantitative data were keyboarded and a descriptive analysis was conducted. RESULTS: It was observed that 97% of the men were satisfied because they had undergone the surgery and only a few of them mentioned undesired effects. Among the few dissatisfied men, only one had had vasectomy reversal because he lived with a new partner and wanted to have children; among the others, dissatisfaction was due to the pain caused by the surgical procedure. The majority of the interviewees attributed to vasectomy changes for the best in their health, body, general relationship with their families and wives, in their sexual life and economic situation. The idea that prevailed was that vasectomy had brought only benefits. The possibility of regret was mentioned by the interviewees as something that would not happen to them. CONCLUSION: The results of this study allowed to verify that men who decide to have a vasectomy tend to see the method as a factor of positive changes, mainly in the sexual life and in the relationship with the partner and family in general.

  17. Medical emergencies in the dental surgery. Part 1: Preparation of the office and basic management.

    Science.gov (United States)

    Malamed, Stanley F

    2015-12-01

    Medical emergencies can and do happen in the dental surgery. In the 20- to 30-year practice lifetime of the typical dentist, he/she will encounter between five and seven emergency situations. Being prepared in advance of the emergency increases the likelihood of a successful outcome. PURPOSE OF THE PAPER: To prepare members of the dental office staff to be able to promptly recognize and efficiently manage those medical emergency situations that can occur in the dental office environment. Preparation of the dental office to promptly recognize and efficiently manage medical emergencies is predicated on successful implementation of the following four steps: basic life support for ALL members of the dental office staff; creation of a dental office emergency team; activation of emergency medial services (EMS) when indicated; and basic emergency drugs and equipment. The basic emergency algorithm (P->C->A->B->D) is designed for implementation in all emergency situations. Prompt implementation of the basic emergency management protocol can significantly increase the likelihood of a successful result when medical emergencies occur in the dental office environment.

  18. Emerging risks and outcomes of blood transfusion in surgery.

    Science.gov (United States)

    Shander, Aryeh

    2004-01-01

    Prior to 1900, blood transfusions were fraught with danger and often caused more complications than the underlying disease. Discovery of the ABO compatibility system in the early twentieth century opened the modern era of blood transfusion, yet ABO incompatibility-as a result of clerical error-remains a significant threat to the recipient today. The risk of disease transmission now includes new and emerging agents, such as Trepanosoma cruzii and West Nile Virus (WNV), as well as other existing pathogens. Transfusion-related immunomodulation (TRIM) presents a further risk to recipient patients. Confounding these problems are shortages of safe blood and the accelerated rise in the cost of blood due to increased testing. Outcome data on transfusion therapy have not always been favorable, particularly in the areas of postoperative infection, systemic inflammatory response syndrome (SIRS), multiple organ failure (MOF), and mortality. Such data have generated extensive efforts to determine association versus underlying cause of post-transfusion complications. In addition, unprecedented global initiatives to minimize the use of allogeneic blood are on the way. Options may include, but are not limited to, the use of "blood substitutes," although validation of such products is still required. In the meantime, blood product conservation techniques should become part of routine transfusion medicine.

  19. Emergency canine surgery in a deployed forward surgical team: a case report.

    Science.gov (United States)

    Beitler, Alan L; Jeanette, Joseph P; McGraw, Andrew L; Butera, Jennifer R; Vanfosson, Christopher A; Seery, Jason M

    2011-04-01

    Forward surgical teams (FSTs) perform a variety of non-doctrinal functions. During their deployment to Afghanistan, the 541st FST (Airborne) performed emergency surgery on a German shepherd military working dog (MWD). Retrospective examination of a case of veterinary surgery in a deployed FST. A 5 1/2-year-old German shepherd MWD presented with extreme lethargy, tachycardia, excessive drooling, and a firm, distended abdomen. These conditions resulted from gastric dilatation with volvulus. Since evacuation to a veterinarian was untenable, emergency laparotomy was performed in the FST. The gastric dilatation with volvulus was treated by detorsion and gastropexy, and the canine patient fully recovered. Canine surgery can be safely performed in an FST. Based on the number of MWDs deployed throughout the theater, FSTs may be called upon to care for them in the absence of available veterinary care.

  20. Self-expandable metallic stent as a bridge to elective surgery versus emergency surgery for acute malignant colorectal obstruction.

    Science.gov (United States)

    Li, Zhi-Xiong; Wu, Xiao-Hua; Wu, Hai-yan; Chang, Wen-Ju; Chang, Xiu-juan; Yi, Tuo; Shi, Qiang; Chen, Jing-Wen; Feng, Qing-Yang; Zhu, De-Xiang; Wei, Ye; Zhong, Yun-Shi; Xu, Jian-Min

    2016-03-01

    The efficacy and safety of self-expandable metallic stents (SEMSs) as a bridge for patients with acute malignant colorectal obstructions (AMCOs) are still controversial. We conducted this study to evaluate the outcomes of patients with AMCOs treated by different strategies. From January 2010 to March 2014, a total of 171 patients with AMCOs from Zhongshan Hospital were retrospectively enrolled in this study. One hundred twenty patients successfully received stent placement followed by one-stage laparoscopic or open resection in the stent group, and 51 patients received emergency operations in the emergency group. The operation duration and postoperative hospital stay were significantly shorter in the stent group (114.51 ± 28.65 vs. 160.39 ± 58.94 min, P stent group also had significantly reduced intraoperative blood loss and the incidence of postoperative complications compared with the emergency group (61.00 ± 43.70 vs. 121.18 ± 85.90 ml, P stent group was significantly longer than that in the emergency group (53 vs. 41 months, P = 0.034). In subgroup analysis of stent group, the stent laparoscopy group had significantly decreased postoperative complications (P = 0.025), and similar long-term survival (P = 0.81). Stent placement as a bridge to surgery is a safe and feasible procedure and provides significant advantages in terms of short-term outcomes and favorable prognoses for patients with AMCOs. Laparoscopic surgery could be considered as an optimal treatment after stent placement.

  1. Assessment of emergency general surgery care based on formally developed quality indicators.

    Science.gov (United States)

    Ingraham, Angela; Nathens, Avery; Peitzman, Andrew; Bode, Allison; Dorlac, Gina; Dorlac, Warren; Miller, Preston; Sadeghi, Mahsa; Wasserman, Deena D; Bilimoria, Karl

    2017-08-01

    Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators. Through 2 rankings, an expert panel ranked potential quality indicators for validity. We then examined historic compliance with select quality indicators after 4 nonelective procedures (cholecystectomy, appendectomy, colectomy, small bowel resection) at 4 academic centers. Of 25 indicators rated as valid, 13 addressed patient-level quality and 12 addressed hospital-level quality. Adherence with 18 indicators was assessed. Compliance with performing a cholecystectomy for acute cholecystitis within 72 hours of symptom onset ranged from 45% to 76%. Compliance with surgery start times within 3 hours from the decision to operate for uncontained perforated viscus ranged from 20% to 100%. Compliance with exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of the decision to operate was 0% to 88%. For 3 quality indicators (auditing 30-day unplanned readmissions/operations for patients previously managed nonoperatively, monitoring time to source control for intra-abdominal infections, and having protocols for bypass/transfer), none of the hospitals were compliant. Developing indicators for providers to assess their performance provides a foundation for specific initiatives. Adherence to quality indicators may improve the quality of emergency general surgery care provided for which current outcomes are potentially modifiable. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2013-04-01

    The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies.

  3. Bariatric Surgery for Adolescents with Type 2 Diabetes: an Emerging Therapeutic Strategy.

    Science.gov (United States)

    Stefater, M A; Inge, T H

    2017-08-01

    Type 2 diabetes (T2D) is a growing public health problem in youth, but conventional treatments are often insufficient to treat this disease and its comorbidities. We review evidence supporting an emerging role for bariatric surgery as a treatment for adolescent T2D. Paralleling what has been seen in adult patients, bariatric surgery dramatically improves glycemic control in patients with T2D. In fact, remission of T2D has been observed in as many as 95-100% of adolescents with diabetes after bariatric surgery, particularly vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) surgery. This striking outcome may be due to both weight-dependent- and weight-independent factors, and recent studies suggest that T2D-related comorbidities may also improve after surgery. Bariatric surgery including RYGB and VSG is a powerful therapeutic option for obese adolescents with T2D. Benefits must be weighed against risk for postoperative complications such as nutritional deficiencies, but earlier surgical intervention might lead to more complete metabolic remission in obese patients with T2D.

  4. Creation of an emergency surgery service concentrates resident training in general surgical procedures.

    Science.gov (United States)

    Ahmed, Hesham M; Gale, Stephen C; Tinti, Meredith S; Shiroff, Adam M; Macias, Aitor C; Rhodes, Stancie C; Defreese, Marissa A; Gracias, Vicente H

    2012-09-01

    Emergency general surgery (EGS) is increasingly being provided by academic trauma surgeons in an acute care surgery model. Our tertiary care hospital recently changed from a model where all staff surgeons (private, subspecialty academic, and trauma academic) were assigned EGS call to one in which an emergency surgery service (ESS), staffed by academic trauma faculty, cares for all EGS patients. In the previous model, many surgeries were "not covered" by residents because of work-hour restrictions, conflicting needs, or private surgeon preference. The ESS was separate from the trauma service. We hypothesize that by creating a separate ESS, residents can accumulate needed and concentrated operative experience in a well-supervised academic environment. A prospectively accrued EGS database was retrospectively queried for the 18-month period: July 2010 to June 2011. The Accreditation Council for Graduate Medical Education (ACGME) databases were queried for operative numbers for our residency program and for national resident data for 2 years before and after creating the ESS. The ACGME operative requirements were tabulated from online sources. ACGME requirements were compared with surgical cases performed. During the 18-month period, 816 ESS operations were performed. Of these, 307 (38%) were laparoscopy. Laparoscopic cholecystectomy and appendectomy were most common (138 and 145, respectively) plus 24 additional laparoscopic surgeries. Each resident performed, on average, 34 basic laparoscopic cases during their 2-month rotation, which is 56% of their ACGME basic laparoscopic requirement. A diverse mixture of 70 other general surgical operations was recorded for the remaining 509 surgical cases, including reoperative surgery, complex laparoscopy, multispecialty procedures, and seldom-performed operations such as surgery for perforated ulcer disease. Before the ESS, the classes of 2008 and 2009 reported that only 48% and 50% of cases were performed at the main academic

  5. The laparoscopic approach in emergency surgery: A review of the literature

    Directory of Open Access Journals (Sweden)

    Ionut Negoi

    2018-01-01

    Full Text Available The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in bdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

  6. Process mapping as a framework for performance improvement in emergency general surgery.

    Science.gov (United States)

    DeGirolamo, Kristin; D'Souza, Karan; Hall, William; Joos, Emilie; Garraway, Naisan; Sing, Chad Kim; McLaughlin, Patrick; Hameed, Morad

    2018-02-01

    Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement. We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge. Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access. Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.

  7. Surgery of the elderly in emergency room mode. Is there a place for laparoscopy?

    Science.gov (United States)

    Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Zacharz, Krzysztof

    2017-06-01

    An important yet difficult problem is qualification for surgery in elderly patients. With age the risk of comorbidities increases - multi-disease syndrome. Elderly patients suffer from frailty syndrome. Many body functions become impaired. All these factors make the elderly patient a major challenge for surgical treatment. Analysis of the possibility of developing the indications and contraindications and the criteria for surgical treatment of the elderly based on our own cases. Discussion whether there is a place for laparoscopy during surgery of the elderly in emergency room (ER) mode. The analysis was performed based on seven cases involving surgical treatment of elderly patients who were admitted to the hospital in emergency room mode. The patients were hospitalized in the General and Minimally Invasive Surgery Clinic in Olsztyn in 2016. Surgical treatment of elderly patients should be planned with multidisciplinary teams. Geriatric surgery centers should be developed to minimize the risk of overzealous treatment and potential complications. Laparoscopy should always be considered in the case of ER procedures or diagnostics. Elderly patients should not be treated as typical adults, but as a separate group of patients requiring special treatment. Due to the existing additional disease in the elderly, the frailty syndrome, any surgical intervention should be minimally invasive. The discussion about therapy should be conducted by a team of specialists from a variety of medical fields.

  8. Type of incision does not predict abdominal wall outcome after emergency surgery for colonic anastomotic leakage

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Oma, Erling; Harling, Henrik

    2017-01-01

    for anastomotic leakage were included with a median follow-up of 5.4 years. Incisional hernia occurred in 41 of 227 (15.3%) patients undergoing midline incision compared with 14 of 81 (14.7%) following transverse incision, P = 1.00. After adjusting for confounders, there was no association between the type...... not predict abdominal wall outcome after emergency surgery for colonic anastomotic leakage....

  9. 1950-nm diode laser-assisted microanastomoses (LAMA): an innovative surgical tool for hand surgery emergencies.

    Science.gov (United States)

    Leclère, Franck Marie; Schoofs, Michel; Vogt, Peter; Casoli, Vincent; Mordon, Serge

    2015-05-01

    Based on previous observations, the 1950-nm diode laser seems to be an ideal wavelength for laser microvascular anastomoses. The data presented here, part of a larger ongoing study, assess its use in emergency hand surgery. Between 2011 and 2014, 11 patients were operated on for hand trauma with laser-assisted microanastomoses (LAMA) and prospectively analysed. LAMA was performed with a 1950-nm diode laser after placement of equidistant stitches. For vessel size laser parameters were used: spot size 400 μm, five spots for each wall, power 125 mW, and arterial/venous fluence 100/90 J/cm(2) (spot duration 1/0.9 s). Mean operating time for arterial and venous microanastomoses was 7.3 ± 1.4 and 8.7 ± 1.0 min, respectively. Three anastomoses required a secondary laser application. Arterial and venous patency rates were 100 % at the time of surgery. The success rate for the 11 procedures assessed clinically and with the Doppler was 100 %. The technique is compared to the current literature. The 1950-nm LAMA is a reliable tool with excellent results in emergency hand surgery. The system is very compact and transportable for utilization in the emergency operating room.

  10. [Intra-anesthetic arterial hypotension in elderly patients during emergency surgery: what are the risk factors?

    Science.gov (United States)

    Boubacar Ba, El Hadji; Leye, Papa Alassane; Traoré, Mamadou Mour; Ndiaye, Pape Ibrahima; Gaye, Ibrahima; Bah, Mamadou Diawo; Fall, Mamadou Lamine; Diouf, Elisabeth

    2017-01-01

    Emergency anesthesia in elderly patients aged 65 years and older is complex. The occurrence of intraoperative incidents and arterial hypotension is conditioned by patients' initial health status and by the quality of intraoperative management. This study aimed to determine the incidence of intra-anesthetic arterial hypotension in elderly patients during emergency surgery and to assess the involvement of certain factors in its occurrence: age, sex, patient's history, ASA class, anesthetic technique. We conducted a retrospective descriptive and analytical study in the Emergency Surgery Department at the Aristide Le Dantec University Hospital from 1 March 2014 to 28 February 2015. We collected data from 210 patients out of 224 elderly patients aged 65 years and older undergoing emergency anesthesias (10.93%). Data of 101 men and 109 women were included in the analysis, of whom 64.3% had at least one defect. Patients' preoperative status was assessed using American Society of Anesthesiology (ASA) classification: 71% of patients were ASA class 1 and 2 and 29% were ASA class 3 and 4. Locoregional anesthesia was the most practiced anesthetic technique (56.7%). 28 patients (13.33%) had intra-anesthetic arterial hypotension, of whom 16 under general anesthesia and 12 under locoregional anesthesia. It was more frequent in patients with high ASA class and a little less frequent in patients with PAH and underlying heart disease. Arterial hypotension in elderly patients during emergency surgery exposes the subject to the risk of not negligible intraoperative hypotension, especially in patients with high ASA class. Prevention is based on adequate preoperative assessment and anesthetic management.

  11. Antroduodenectomy with Gastroduodenal Anastomosis: Salvage Emergency Surgery for Complicated Peptic Ulcer Disease--Results of a Double Institution Study of 35 Patients.

    Science.gov (United States)

    Chereau, Nathalie; Chandeze, Marie-Maëlle; Tantardini, Camille; Trésallet, Christophe; Lefevre, Jérémie H; Parc, Yann; Menegaux, Fabrice

    2016-03-01

    Endoscopic and interventional techniques are currently the mainstay of management of bleeding duodenal ulcer. As well, for patients with perforated duodenal ulcer, laparoscopic simple closure is nowadays usually performed. Although indications for emergency antroduodenectomy have declined, this procedure is still necessary as a salvage option when conservative management has failed or is not practicable. Our study aimed to evaluate indications and results of antroduodenectomy with gastroduodenal anastomosis in current practice and to examine the factors that predict operative outcomes. All patients who underwent emergency antroduodenectomy with gastroduodenal anastomosis in two surgical care departments specialized in emergency digestive surgery were studied from 2000 to 2015. Thirty-five patients (27 males, 77 %) with a median age of 68 years (20-90) underwent emergency antroduodenectomy with gastroduodenal anastomosis. Indications were bleeding and perforated duodenal ulcer in 24 and 11 patients, respectively. The overall complication rate was 69 %, especially because of a high rate of medical complications (57 %). Only two patients (6 %) required reoperation for anastomotic leakage. The overall mortality rate was 40 % (n = 14). According to the univariate analysis, age >70, >3 comorbidities, ASA score >2, and postoperative medical complications were associated with an increased risk of in-hospital mortality. In the multivariate analysis, age and ASA score remained independent risk factors. No recurrence of complicated duodenal disease was observed. Antroduodenectomy with gastroduodenal anastomosis is a safe and effective long-term strategy, with a low and acceptable rate of surgical complications, for complicated duodenal ulcer not responding to conservative measures.

  12. Unplanned emergency department consultations and readmissions within 30 and 90 days of bariatric surgery.

    Science.gov (United States)

    Iskra, María P; Ramón, José M; Martínez-Serrano, Andrés; Serra, Carmen; Goday, Albert; Trillo, Lourdes; Lanzarini, Enrique; Pera, Manuel; Grande, Luis

    2018-04-01

    Hospital readmission is used as a measure of quality healthcare. The aim of this study was to determine the incidence, causes, and risk factors related to emergency consultations and readmissions within 30 and 90 days in patients undergoing laparoscopic gastric bypass and laparoscopic sleeve gastrectomy. Retrospective study of 429 patients operated on from January 2004 to July 2015 from a prospectively maintained database and electronic medical records. Demographic data, type of intervention, postoperative complications, length of hospital stay and records of emergency visits and readmissions were analyzed. Within the first 90 days postoperative, a total of 117 (27%) patients consulted the Emergency Department and 24 (6%) were readmitted. The most common reasons for emergency consultation were noninfectious problems related to the surgical wound (n=40, 34%) and abdominal pain (n=28, 24%), which was also the first cause of readmission (n=9, 37%). Postoperative complications, reintervention, associated surgery in the same operation and depression were risk factors for emergency consultation within the first 90 days of the postoperative period. Despite the high number of patients who visit the Emergency Department in the first 90 days of the postoperative period, few require readmission and none surgical reoperation. It is important to know the reasons for emergency consultation to establish preventive measures and improve the quality of care. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Outcomes of hospitalized patients undergoing emergency general surgery remote from admission.

    Science.gov (United States)

    Sharoky, Catherine E; Bailey, Elizabeth A; Sellers, Morgan M; Kaufman, Elinore J; Sinnamon, Andrew J; Wirtalla, Christopher J; Holena, Daniel N; Kelz, Rachel R

    2017-09-01

    Emergency general surgery during hospitalization has not been well characterized. We examined emergency operations remote from admission to identify predictors of postoperative 30-day mortality, postoperative duration of stay >30 days, and complications. Patients >18 years in The American College of Surgeons National Surgical Quality Improvement Program (2011-2014) who had 1 of 7 emergency operations between hospital day 3-18 were included. Patients with operations >95th percentile after admission (>18 days; n = 581) were excluded. Exploratory laparotomy only (with no secondary procedure) represented either nontherapeutic or decompressive laparotomy. Multivariable logistic regression was used to identify predictors of study outcomes. Of 10,093 patients with emergency operations, most were elderly (median 66 years old [interquartile ratio: 53-77 years]), white, and female. Postoperative 30-day mortality was 12.6% (n = 1,275). Almost half the cohort (40.1%) had a complication. A small subset (6.8%) had postoperative duration of stay >30 days. Postoperative mortality after exploratory laparotomy only was particularly high (>40%). In multivariable analysis, an operation on hospital day 11-18 compared with day 3-6 was associated with death (odds ratio 1.6 [1.3-2.0]), postoperative duration of stay >30 days (odds ratio 2.0 [1.6-2.6]), and complications (odds ratio 1.5 [1.3-1.8]). Exploratory laparotomy only also was associated with death (odds ratio 5.4 [2.8-10.4]). Emergency general surgery performed during a hospitalization is associated with high morbidity and mortality. A longer hospital course before an emergency operation is a predictor of poor outcomes, as is undergoing exploratory laparotomy only. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. [Pediatric anesthesia emergence delirium after elective ambulatory surgery: etiology, risk factors and prevalence].

    Science.gov (United States)

    Gololobov, Alik; Todris, Liat; Berman, Yakov; Rosenberg-Gilad, Zipi; Schlaeffer, Pnina; Kenett, Ron; Ben-Jacob, Ron; Segal, Eran

    2015-04-01

    Emergence delirium (ED) is a common problem among children and adults recovering from general anesthesia after surgery. Its symptoms include psychomotor agitation, hallucinations, and aggressive behavior. The phenomenon, which is most probably an adverse effect of general anesthesia agents, harms the recovery process and endangers the physical safety of patients and their health. Ranging between 10% and 80%, the exact prevalence of ED is unknown, and the risk factors of the phenomenon are unclear. The aim of the current retrospective study was to determine the prevalence rate of ED in 3947 children recovering from general anesthesia after short elective ambulatory surgery, and to map the influence of various risk factors on this phenomenon. Data were collected using electronic medical records. ED severity was assessed using the Pediatric Anesthesia Emergence Delirium Scale. Results showed the prevalence of ED among children. ED was significantly correlated with patients' age, type of surgery and premedication. ED was not correlated with severity of pain, type of anesthesia or with patients' sex.

  15. Analysis of 230 cases of emergent surgery for obstructing colon cancer--lessons learned.

    Science.gov (United States)

    Aslar, Ahmet Kessaf; Ozdemir, Süleyman; Mahmoudi, Hatim; Kuzu, Mehmet Ayhan

    2011-01-01

    We aimed to identify prognostic factors affecting clinical outcomes in emergent primary resection. A retrospective analysis of prospectively acquired data of 230 consecutive emergent patients between August 1994 and January 2005 were evaluated in this study. Sixty-nine patients applied with right colon obstruction and 161 patients with left. Resection and primary anastomosis was carried out in 128 patients and resection and stoma in 102 patients. The patients were divided into two cohorts: patients who developed poor outcome within 30 days after surgery and those who did not. Major morbidity or mortality were reported in 60 (26.1%) patients. Analysis revealed that the most important prognostic factors for poor outcome were American Anesthesiology Association (ASA) grade ≥3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥11, age >60 years, presence of peritonitis, and surgery during on-call hours. Age >60 years and on-call surgery were determinant factors in right-sided obstructions, whereas ASA grade ≥3, APACHE II score ≥11, and presence of peritonitis were determinant factors in left-sided obstructions. All these factors but the timing of the operation emphasize the pivotal role of the patient's physiological condition on admission. Accurate preoperative evaluation might predict the clinical outcome and help in establishing the most appropriate treatment.

  16. Emergency pediatric surgery: Comparing the economic burden in specialized versus nonspecialized children's centers.

    Science.gov (United States)

    Kvasnovsky, Charlotte L; Lumpkins, Kimberly; Diaz, Jose J; Chun, Jeannie Y

    2018-05-01

    The American College of Surgeons has developed a verification program for children's surgery centers. Highly specialized hospitals may be verified as Level I, while those with fewer dedicated resources as Level II or Level III, respectively. We hypothesized that more specialized children's centers would utilize more resources. We performed a retrospective study of the Maryland Health Services Cost Review Commission (HSCRC) database from 2009 to 2013. We assessed total charge, length of stay (LOS), and charge per day for all inpatients with an emergency pediatric surgery diagnosis, controlling for severity of illness (SOI). Using published resources, we assigned theoretical level designations to each hospital. Two hospitals would qualify as Level 1 hospitals, with 4593 total emergency pediatric surgery admissions (38.5%) over the five-year study period. Charges were significantly higher for children treated at Level I hospitals (all P<0.0001). Across all SOI, children at Level I hospitals had significantly longer LOS (all P<0.0001). Hospitals defined as Level II and Level III provided the majority of care and were able to do so with shorter hospitalizations and lower charges, regardless of SOI. As care shifts towards specialized centers, this charge differential may have significant impact on future health care costs. Level III Cost Effectiveness Study. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. Current and emerging basic science concepts in bone biology: implications in craniofacial surgery.

    Science.gov (United States)

    Oppenheimer, Adam J; Mesa, John; Buchman, Steven R

    2012-01-01

    Ongoing research in bone biology has brought cutting-edge technologies into everyday use in craniofacial surgery. Nonetheless, when osseous defects of the craniomaxillofacial skeleton are encountered, autogenous bone grafting remains the criterion standard for reconstruction. Accordingly, the core principles of bone graft physiology continue to be of paramount importance. Bone grafts, however, are not a panacea; donor site morbidity and operative risk are among the limitations of autologous bone graft harvest. Bone graft survival is impaired when irradiation, contamination, and impaired vascularity are encountered. Although the dura can induce calvarial ossification in children younger than 2 years, the repair of critical-size defects in the pediatric population may be hindered by inadequate bone graft donor volume. The novel and emerging field of bone tissue engineering holds great promise as a limitless source of autogenous bone. Three core constituents of bone tissue engineering have been established: scaffolds, signals, and cells. Blood supply is the sine qua non of these components, which are used both individually and concertedly in regenerative craniofacial surgery. The discerning craniofacial surgeon must determine the proper use for these bone graft alternatives, while understanding their concomitant risks. This article presents a review of contemporary and emerging concepts in bone biology and their implications in craniofacial surgery. Current practices, areas of controversy, and near-term future applications are emphasized.

  18. [A case of emergency surgery in a patient with bronchial asthma under continuous spinal anesthesia].

    Science.gov (United States)

    Noda, Keiichi; Ryo, Kenshu; Nakamoto, Ai

    2003-10-01

    A 78-year-old male, observed for bronchial asthma, underwent two emergency operations within eight days. The first operation was performed under general anesthesia with tracheal intubation. Anesthesia was maintained by sevoflurane-oxygen and continuous infusion of propofol in combination with epidural injection of lidocaine. During the operation, respiratory sound was almost clear. But wheezing occurred as he awoke after discontinuation of the anesthetics. He needed ventilatory support for three days for status asthmatics. The second operation was performed under continuous spinal anesthesia using hypobaric tetracaine and hyperbaric bupivacaine. No ventilatory support was necessary after the operation and he was discharged uneventfully.

  19. H1N1 infection in emergency surgery: A cautionary tale.

    LENUS (Irish Health Repository)

    Galbraith, J G

    2010-01-01

    Pandemic 2009 influenza A H1N1 has spread rapidly since its first report in Mexico in March 2009. This is the first influenza pandemic in over 40 years and it atypically affects previously healthy young adults, with higher rates of morbidity and mortality. The medical literature has been inundated with reports of H1N1 infection, the majority found in critical care and internal medicine journals with a relative paucity in the surgical literature. Despite this, it remains an important entity that can impact greatly on acute surgical emergencies. We present a case of previously healthy 31-year-old male who underwent open appendectomy. His post-operative recovery was complicated by acute respiratory distress syndrome secondary to H1N1 infection. This case report highlights the impact that H1N1 virus can have on acute surgical emergencies and how it can complicate the post-operative course.

  20. Recurrent sigmoid volvulus - early resection may obviate later emergency surgery and reduce morbidity and mortality.

    LENUS (Irish Health Repository)

    Larkin, J O

    2012-01-31

    INTRODUCTION: Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS: We reviewed our unit\\'s experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS: Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS: Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.

  1. Anesthesia through an intraosseous line using an 18-gauge intravenous needle for emergency pediatric surgery.

    Science.gov (United States)

    Hamed, Riyadh Khudeir; Hartmans, Sharon; Gausche-Hill, Marianne

    2013-09-01

    To describe the success and complication rate of intraosseous (IO) access for delivery of anesthesia with the use of an 18-gauge (G) intravenous (IV) needle. Prospective study. Children's Welfare Teaching Hospital, Baghdad, Iraq. 300 critically ill infants and toddlers, age 3 weeks to 16 months, requiring emergency surgery for intra-abdominal or pelvic conditions, in whom peripheral or central access was not obtainable. Patients presented for surgery between 2007 and 2010. In 26 patients, the IO catheter was established when peripheral access was not obtained at the outset of surgery; in 4 patients standard peripheral vascular access failed during the surgical procedure and IO access was obtained. An 18-G IV needle was placed into the proximal tibia and attached to an extension set with a 3-way stopcock to deliver anesthesia. For 26 critically ill children and 4 other children, IV access failed during delivery of anesthesia; vascular access was successfully obtained within minutes in all 30 infants (100%) using the intraosseous route. Ninety percent (27/30) of patients awoke immediately postoperatively in good condition; 10% (3/30) went to the pediatric intensive care unit (PICU) for further care due to their critical preoperative condition. Complications associated with use of the IO route were considered minor (3/30 pts [10%]) and included extravasation of fluid in two cases and cellulitis in one. The IO route provided for rapid delivery of anesthesia, induction, and maintenance in this series of critically ill infants undergoing emergency surgery when other vascular access routes failed. Few complications were noted. Intraosseous access was achieved through a simple technique using an 18-gauge IV needle. © 2013 Elsevier Inc. All rights reserved.

  2. Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis

    Science.gov (United States)

    Lees, Mackenzie C.; Merani, Shaheed; Tauh, Keerit; Khadaroo, Rachel G.

    2015-01-01

    Background Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery. Methods We conducted a retrospective cohort study of patients aged 65–80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home. Results Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) class (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.43–10.33, p = 0.008) and in-hospital complications (OR 1.93, 95% CI 1.32–2.83, p = 0.001). Nearly two-thirds of patients discharged home were younger (OR 0.92, 95% CI 0.85–0.99, p = 0.036), had lower ASA class (OR 0.45, 95% CI 0.27–0.74, p = 0.002) and fewer in-hospital complications (OR 0.69, 95% CI 0.53–0.90, p = 0.007). Conclusion American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home. PMID:26204143

  3. Emergency general surgery in a low-middle income health care setting: Determinants of outcomes.

    Science.gov (United States)

    Shah, Adil A; Latif, Asad; Zogg, Cheryl K; Zafar, Syed Nabeel; Riviello, Robert; Halim, Muhammad Sohail; Rehman, Zia; Haider, Adil H; Zafar, Hasnain

    2016-02-01

    Emergency general surgery (EGS) has emerged as an important component of frontline operative care. Efforts in high-income settings have described its burden but have yet to consider low- and middle-income health care settings in which emergent conditions represent a high proportion of operative need. The objective of this study was to describe the disease spectrum of EGS conditions and associated factors among patients presenting in a low-middle income context. March 2009-April 2014 discharge data from a university teaching hospital in South Asia were obtained for patients (≥16 years) with primary International Classification of Diseases, 9(th) revision, Clinical Modification diagnosis codes consistent with an EGS condition as defined by the American Association for the Surgery of Trauma. Outcomes included in-hospital mortality and occurrence of ≥1 major complication(s). Multivariable analyses were performed, adjusting for differences in demographic and case-mix factors. A total of 13,893 discharge records corresponded to EGS conditions. Average age was 47.2 years (±16.8, standard deviation), with a male preponderance (59.9%). The majority presented with admitting diagnoses of biliary disease (20.2%), followed by soft-tissue disorders (15.7%), hernias (14.9%), and colorectal disease (14.3%). Rates of death and complications were 2.7% and 6.6%, respectively; increasing age was an independent predictor of both. Patients in need of resuscitation (n = 225) had the greatest rates of mortality (72.9%) and complications (94.2%). This study takes an important step toward quantifying outcomes and complications of EGS, providing one of the first assessments of EGS conditions using American Association for the Surgery of Trauma definitions in a low-middle income health care setting. Further efforts in varied settings are needed to promote representative benchmarking worldwide. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Geriatric emergency general surgery: Survival and outcomes in a low-middle income country.

    Science.gov (United States)

    Shah, Adil A; Haider, Adil H; Riviello, Robert; Zogg, Cheryl K; Zafar, Syed Nabeel; Latif, Asad; Rios Diaz, Arturo J; Rehman, Zia; Zafar, Hasnain

    2015-08-01

    Geriatric patients remain largely unstudied in low-middle income health care settings. The purpose of this study was to compare the epidemiology and outcomes of older versus younger adults with emergency general surgical conditions in South Asia. Discharge data from March 2009 to April 2014 were obtained for all adult patients (≥16 years) with an International Classification of Diseases, 9th revision, Clinical Modification diagnosis codes consistent with an emergency general surgery condition as defined by the American Association for the Surgery of Trauma. Multivariable regression analyses compared patients >65 years of age with patients ≤65 years for differences in all-cause mortality, major complications, and duration of hospital stay. Models were adjusted for potential confounding owing to patient demographic and clinical case-mix data with propensity scores. We included 13,893 patients; patients >65 years constituted 15% (n = 2,123) of the cohort. Relative to younger patients, older adults were more likely to present with a number of emergency general surgery conditions, including gastrointestinal bleeding (odds ratio OR [95% CI], 2.63[1.99-3.46]), resuscitation (2.17 [1.67-2.80]), and peptic ulcer disease (2.09 [1.40-3.10]). They had an 89% greater risk-adjusted odds (1.89 [1.55-2.29]) of complications and a 63% greater odds (1.63 [1.21-2.20]) of mortality. Restricted to patients undergoing operative interventions, older adults had 95% greater odds (1.95 [1.29-2.94]) of complications and 117% greater odds (2.17 [1.62-2.91]) of mortality. Understanding unique needs of geriatric patients is critical to enhancing the management and prioritization of appropriate care in developing settings. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding.

    Science.gov (United States)

    Peeraully, R; Henderson, K; Davies, B

    2016-04-01

    Introduction In England, emergency readmissions within 30 days of hospital discharge after an elective admission are not reimbursed if they do not meet Payment by Results (PbR) exclusion criteria. However, coding errors could inappropriately penalise hospitals. We aimed to assess the accuracy of coding for emergency readmissions. Methods Emergency readmissions attributed to paediatric surgery and urology between September 2012 and August 2014 to our tertiary referral centre were retrospectively reviewed. Payment by Results (PbR) coding data were obtained from the hospital's Family Health Directorate. Clinical details were obtained from contemporaneous records. All readmissions were categorised as appropriately coded (postoperative or nonoperative) or inappropriately coded (planned surgical readmission, unrelated surgical admission, unrelated medical admission or coding error). Results Over the 24-month period, 241 patients were coded as 30-day readmissions, with 143 (59%) meeting the PbR exclusion criteria. Of the remaining 98 (41%) patients, 24 (25%) were inappropriately coded as emergency readmissions. These readmissions resulted in 352 extra bed days, of which 117 (33%) were attributable to inappropriately coded cases. Conclusions One-quarter of non-excluded emergency readmissions were inappropriately coded, accounting for one-third of additional bed days. As a stay on a paediatric ward costs up to £500 a day, the potential cost to our institution due to inappropriate readmission coding was over £50,000. Diagnoses and the reason for admission for each care episode should be accurately documented and coded, and readmission data should be reviewed at a senior clinician level.

  6. Social media in plastic surgery practices: emerging trends in North America.

    Science.gov (United States)

    Wheeler, Chad K; Said, Hakim; Prucz, Roni; Rodrich, Rod J; Mathes, David W

    2011-05-01

    Social media is a common term for web-based applications that offer a way to disseminate information to a targeted audience in real time. In the current market, many businesses are utilizing it to communicate with clients. Although the field of plastic surgery is constantly changing in response to innovative technologies introduced into the specialty, the utilization of social media in plastic surgery practices is currently unclear. The authors evaluate the current attitudes and practices of aesthetic surgeons to emerging social media technology and compare these to attitudes about more traditional modes of communication. A 19-question web-based survey was disseminated by e-mail to all board-certified or board-eligible American plastic surgeons (n = 4817). Respondents were asked to answer questions on three topics: (1) their use of social media in their personal and professional lives, (2) their various forms of practice marketing, and (3) their demographic information. There were 1000 responses (20.8%). Results showed that 28.2% of respondents used social media in their practice, while 46.7% used it in their personal life. Most plastic surgeons managed their social media themselves or through a staff member. The majority of respondents who used social media in their practice claimed that their efforts were directed toward patient referrals. The typical plastic surgery practice that used social media was a solo practice in a large city with a focus on cosmetic surgery. Local competition of plastic surgeons did not correlate with social media use. Most plastic surgeons (88%) advertised, but the form of marketing varied. The most common forms included websites, print, and search engine optimization, but other modalities, such as television, radio, and billboards, were still utilized. Social media represents a new avenue that many plastic surgeons are utilizing, although with trepidation. As social media becomes commonplace in society, its role in plastic surgery

  7. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery.

    Science.gov (United States)

    Ahiskalioglu, Elif Oral; Ahiskalioglu, Ali; Firinci, Binali; Dostbil, Aysenur; Aksoy, Mehmet

    2015-01-01

    Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  8. Introduction of a fresh cadaver laboratory during the surgery clerkship improves emergency technical skills.

    Science.gov (United States)

    Nematollahi, Saman; Kaplan, Stephen J; Knapp, Christopher M; Ho, Hang; Alvarado, Jared; Viscusi, Rebecca; Adamas-Rappaport, William

    2015-08-01

    Student acquisition of technical skills during the clinical years of medical school has been steadily declining. To address this issue, the authors instituted a fresh cadaver-based Emergency Surgical Skills Laboratory (ESSL). Sixty-three medical students rotating through the third-year surgery clerkship participated in a 2-hour, fresh cadaver-based ESSL conducted during the first 2 days of the clerkship. The authors evaluated students utilizing both surgical skills and written examination before the ESSL and at 4 weeks post ESSL. Students demonstrated a mean improvement of 64% (±11) (P cadaver laboratory is an effective method to provide proficiency in emergency technical skills not acquired during the clinical years of medical school. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery

    Directory of Open Access Journals (Sweden)

    Elif Oral Ahiskalioglu

    2015-11-01

    Full Text Available Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

  10. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery

    Directory of Open Access Journals (Sweden)

    Elif Oral Ahiskalioglu

    2015-12-01

    Full Text Available ABSTRACT Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

  11. Ostomy-related complications after emergent abdominal surgery: a 2-year follow-up study.

    Science.gov (United States)

    Lindholm, Elisabet; Persson, Eva; Carlsson, Eva; Hallén, Anne-Marie; Fingren, Jeanette; Berndtsson, Ina

    2013-01-01

    The aim of this study was to prospectively evaluate ostomy-related complications and describe ostomy configuration in patients undergoing acute abdominal surgery. The study sample comprised 144 patients with a median age of 67 years (IOR: 53.5-78 years) who underwent an intestinal ostomy as part of an acute abdominal surgical procedure. The research setting was the surgical and gynecological clinics at the Sahlgrenska University Hospital in Gothenburg, Sweden. Ostomy configuration, diameter, height, and the presence of stomal and peristomal complications were assessed by a WOC nurse 1 to 2 times while in hospital, once at the ostomy outpatient clinic 2 weeks after discharge, and at 3, 6, 12, and 24 months following ostomy creation. The types of ostomies evaluated were end colostomy (58%), end ileostomy (18%), loop ileostomy (17%), and loop colostomy (7%). Most stomal or peristomal complications occurred within 1 year after surgery (31 of 57; 54.4%). Necrosis, separation, and stenosis were most common in patients with an end colostomy. Peristomal skin complications occurred in 45% of subjects during the first 6 months after surgery. The ostomy's diameter decreased significantly during the hospital course and over the first 2 weeks following hospital discharge in patients with end colostomy (Postomy had peristomal skin problems ranging between 21% and 57% over this time period. The frequency of using a pouching system that incorporated convexity was highest in the case of loop ileostomy, used in 67% at 6 months. During the first 2 weeks after discharge, the physical configuration of the ostomy evolves and the pouching system must be frequently adjusted by a WOC nurse. Stomal and peristomal complications are prevalent during the first 2 postoperative years and especially during the first 6 months.

  12. Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom.

    Science.gov (United States)

    Sharrock, A E; Gokani, V J; Harries, R L; Pearce, L; Smith, S R; Ali, O; Chu, H; Dubois, A; Ferguson, H; Humm, G; Marsden, M; Nepogodiev, D; Venn, M; Singh, S; Swain, C; Kirkby-Bott, J

    2015-01-01

    The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS. Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.

  13. The Role of Radio Frequency Detection System Embedded Surgical Sponges in Preventing Retained Surgical Sponges: A Prospective Evaluation in Patients Undergoing Emergency Surgery.

    Science.gov (United States)

    Inaba, Kenji; Okoye, Obi; Aksoy, Hande; Skiada, Dimitra; Ault, Glenn; Sener, Stephen; Lam, Lydia; Benjamin, Elizabeth; Demetriades, Demetrios

    2016-10-01

    To prospectively evaluate the ability of radio frequency detection (RFD) system-embedded sponges to mitigate the incidence of retained surgical sponges (RSS) after emergency surgery. Emergency surgery patients are at high risk for retained foreign bodies. All emergent trauma and nontrauma cavitary operations over a 5-year period (January 2010-December 2014) were prospectively enrolled. For damage-control procedures, only the definitive closure was included. RFD sponges were used exclusively throughout the study period. Before closure, the sponge and instrument count was followed by RFD scanning and x-ray evaluation for retained sponges. RSS and near-misses averted using the RFD system were analyzed. In all, 2051 patients [median (range)], aged 41 (1-101) years, 72.2% male, 46.8% trauma patients, underwent 2148 operations (1824 laparotomy, 100 thoracotomy, 30 sternotomy, and 97 combined). RFD detected retained sponges in 11 (0.5%) patients (81.8%laparotomy, 18.2% sternotomy) before cavitary closure. All postclosure x-rays were negative. No retained sponges were missed by the RFD system. Body mass index was 29 (23-43), estimated blood loss 1.0 L (0-23), and operating room time 160 minutes (71-869). Procedures started after 18:00 to 06:00 hours in 45.5% of the patients. The sponge count was incorrect in 36.4%, not performed due to time constraints in 45.5%, and correct in 18.2%. The additional cost of using RFD-embedded disposables was $0.17 for a 4X18 laparotomy sponge and $0.46 for a 10 pack of 12ply, 4X8. Emergent surgical procedures are high-risk for retained sponges, even when sponge counts are performed and found to be correct. Implementation of a RFD system was effective in preventing this complication and should be considered for emergent operations in an effort to improve patient safety.

  14. Earliest signs and management of leakage after bariatric surgeries ...

    African Journals Online (AJOL)

    Mohamed Bekheit

    2012-10-25

    Oct 25, 2012 ... b Department of General Surgery, Faculty of Medicine, Alexandria University, Egypt c Department of ... of sepsis or hemodynamic instability require emergent exploration. .... One failed LGB underwent conversion to LGBP and.

  15. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

    DEFF Research Database (Denmark)

    Vester-Andersen, M; Waldau, T; Wetterslev, J

    2015-01-01

    BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care...... ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. RESULTS: In total, 286 patients were included in the modified intention-to-treat analysis. The trial...... was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2...

  16. Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgery

    DEFF Research Database (Denmark)

    Christiansen, Mia N.; Andersson, Charlotte; Gislason, Gunnar H.

    2017-01-01

    Background: The outcomes of emergent noncardiac, nonintracranial surgery in patients with previous stroke remain unknown. Methods: All emergency surgeries performed in Denmark (2005 to 2011) were analyzed according to time elapsed between previous ischemic stroke and surgery. The risks of 30-day...... mortality and major adverse cardiovascular events were estimated as odds ratios (ORs) and 95% CIs using adjusted logistic regression models in a priori defined groups (reference was no previous stroke). In patients undergoing surgery immediately (within 1 to 3 days) or early after stroke (within 4 to 14...... and general anesthesia less frequent in patients with previous stroke (all P Risks of major adverse cardiovascular events and mortality were high for patients with stroke less than 3 months (20.7 and 16.4% events; OR = 4.71 [95% CI, 4.18 to 5.32] and 1.65 [95% CI, 1.45 to 1.88]), and remained...

  17. Portal venous gas detected on computed tomography in emergency situations: surgery is still necessary.

    Science.gov (United States)

    Monneuse, Olivier; Pilleul, Frank; Barth, Xavier; Gruner, Laurent; Allaouchiche, Bernard; Valette, Pierre-Jean; Tissot, E

    2007-05-01

    Portal venous gas (PVG) has been reported to be associated with lethal surgical diagnosis. Recent studies tend to confirm the clinical significance of gas in the portal vein; however, some patients are managed without surgical treatment. The aim of this study was to assess both the diagnoses and the treatment of patients with PVG in an emergency surgical setting. We performed a retrospective chart review of 15 patients with PVG in the emergency setting detected by computed tomography (CT) between July 1999 and July 2004. Characteristics assessed included age, sex, clinical presentation, first CT diagnosis of both PVG and the underlying pathology, American Society of Anesthesiologists (ASA) score, surgical findings, final clinical diagnosis, duration of hospitalization, and evolution of the illness/mortality. All patients were examined one month after operation. This series of 5 women and 10 men ranged in age from 38 to 90 years at the time they underwent emergency surgical treatment. The mean preoperative ASA score was 4.20. Computed tomography diagnosed the underlying pathology in all cases: bowel obstruction (4 cases), bowel necrosis (9 cases), and diffuse peritonitis (2 cases). The mean length of hospital stay was 12.4 days. The mortality rate was 46.6%; (7 patients). A wide range of pathologies can generate PVG. Computed tomography can detect both the presence of gas and the underlying pathology. In emergency situations, all the diagnosed causal pathologies required a surgical procedure without delay. We report that the prognosis was related to the pathology itself and was not influenced by the presence of PVG.

  18. Ankle Fracture Surgery on a Pregnant Patient Complicated by Intraoperative Emergency Caesarian Section

    Directory of Open Access Journals (Sweden)

    Ran Schwarzkopf

    2013-01-01

    Full Text Available We report the case of a woman in the third trimester of pregnancy who sustained an ankle fracture dislocation that could not be adequately closed reduced. After discussions with the patient, her obstetrician, and the anesthesiologists, she was indicated for surgical fixation. A heart tone monitor was used to assess fetal health during the procedure. During surgical incision, the fetus went into distress, and an emergency caesarian section was performed. After delivery of the infant and abdominal closer, surgery was completed. Due to a cohesive team effort, both the patient and her infant had excellent outcomes. There are many important considerations in the surgical management of the pregnant patient with traumatic orthopaedic injuries. Of especial importance to the orthopaedic surgeon is the impact of patient positioning on uteroplacental blood flow. This report discusses factors that should be taken into account by any orthopaedist who plans to operate on a pregnant patient.

  19. Secondary Bleedings in Oral Surgery Emergency Service: A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Sebastian Igelbrink

    2018-01-01

    Full Text Available Introduction. Bleeding after dental surgery is still a common cause for emergency presentation in patients using anticoagulants. Our aim was to analyze pertinent characteristic features on the one hand and to bare existing problems in handling on the other. Materials and Methods. The study included 76 patients. We documented basic data, anticoagulant medication, type of surgery, and tooth socket sutures in respective patients. Results. The vast majority of patients took a coumarin derivative (41 and acetylsalicylic acid (27. Nine (12% of the patients had to be hospitalized due to ongoing bleeding despite local haemostyptic steps and/or circulatory dysregulation. Most patients could be successfully treated in outpatient settings. No statistically significant correlation between bleeding, level of INR value, number of extracted teeth, and sewed alveoli could be shown. Sixty-five percent of cases with tooth extractions did not have suture of tooth sockets. Eighty-seven percent of the patients denied being informed about possible self-treatment options by their surgeon/dentist, and none of the patients got presurgical-fabricated bandage plate(s. Conclusions. Patients taking coumarin derivative currently, furthermore, represent the biggest anticoagulant after-bleeding group in dentoalveolar surgery. The major part of after-bleedings (90% can be handled in an outpatient setting with simplest surgical interventions. Unfortunately, the biggest part of the patient collective got no suture, no prefabricated dental bandage plate(s, and no explanation by their dentist how to handle in case of after-bleeding. Therefore, dental practitioners should furthermore get enlightenment on how to prevent after-bleeding situations.

  20. Assessing written communication during interhospital transfers of emergency general surgery patients.

    Science.gov (United States)

    Harl, Felicity N R; Saucke, Megan C; Greenberg, Caprice C; Ingraham, Angela M

    2017-06-15

    Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016. Elements of written communication were abstracted from referring facility documents scanned into the medical record using a standardized abstraction protocol. Descriptive statistics summarized the information communicated. A total of 129 patients met inclusion criteria. 87.6% (n = 113) of charts contained referring hospital documents. 42.5% (n = 48) were missing history and physicals. Diagnoses were missing in 9.7% (n = 11). Ninety-one computed tomography scans were performed; among 70 with reads, final reads were absent for 70.0% (n = 49). 45 ultrasounds and x-rays were performed; among 27 with reads, final reads were missing for 80.0% (n = 36). Reasons for transfer were missing in 18.6% (n = 21). Referring hospital physicians outside the ED were consulted in 32.7% (n = 37); consultants' notes were absent in 89.2% (n = 33). In 12.4% (n = 14), referring documents arrived after the patient's ED arrival and were not part of the original documentation provided. This study documents that information important to patient care is often missing in the written communication provided during interhospital transfers. This gap affords a foundation for standardizing provider communication during interhospital transfers. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    Directory of Open Access Journals (Sweden)

    Bates Tom

    2007-06-01

    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  2. Resultado funcional e índice macular em portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna Functional outcome and macular index in macular hole patients who underwent surgery with internal limiting membrane removal

    Directory of Open Access Journals (Sweden)

    José Ricardo Diniz

    2008-04-01

    Full Text Available OBJETIVOS: Avaliar o resultado funcional e o índice macular dos portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna. MÉTODOS: Quinze olhos de 15 pacientes com buraco macular estágios 2, 3 e 4 foram incluídos no estudo. Todos foram submetidos à cirurgia de buraco macular convencional com remoção da membrana limitante interna corada pelo azul de tripan. Melhor acuidade visual com correção e cortes transversais medidos por tomografia de coerência óptica (OCT foram avaliados no pré- e pós-operatório. O índice macular (razão entre a altura e base do buraco macular foi calculado e correlacionado com o diâmetro mínimo do buraco macular e o ganho de acuidade visual pós-operatória. RESULTADOS: Obteve-se fechamento do buraco macular em todos pacientes operados. Em 86,7%, houve ganho de pelo menos três linhas de visão. O índice macular demonstrou correlação negativa significante com o diâmetro mínimo (r=0,811. Não foi observada correlação significante entre o índice macular e o ganho de acuidade visual pós-operatória (r=0,351. CONCLUSÃO: Os resultados funcionais na cirurgia do buraco macular com remoção da membrana limitante interna foram bons neste grupo de pacientes. O índice macular demonstrou ser compatível com a configuração espacial do buraco macular, porém não foi preditor de resultados visuais.PURPOSE: To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS: Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT were evaluated pre- and postoperatively. The macular hole index

  3. Monitoring equine visceral pain with a composite pain scale score and correlation with survival after emergency gastrointestinal surgery

    NARCIS (Netherlands)

    van Loon, Johannes P A M; Jonckheer-Sheehy, Valerie S M; Back, Willem; van Weeren, René; Hellebrekers, Ludo J; Back, Wim

    Recognition and management of equine pain have been studied extensively in recent decades and this has led to significant advances. However, there is still room for improvement in the ability to identify and treat pain in horses that have undergone emergency gastrointestinal surgery. This study

  4. The financial burden of emergency general surgery: National estimates 2010 to 2060.

    Science.gov (United States)

    Ogola, Gerald O; Gale, Stephen C; Haider, Adil; Shafi, Shahid

    2015-09-01

    Adoption of the acute care surgery model has led to increasing volumes of emergency general surgery (EGS) patients at trauma centers. However, the financial burden of EGS services on trauma centers is unknown. This study estimates the current and future costs associated with EGS hospitalization nationwide. We applied the American Association for the Surgery of Trauma's DRG International Classification of Diseases-9th Rev. criteria for defining EGS to the 2010 National Inpatient Sample (NIS) data and identified adult EGS patients. Cost of hospitalization was obtained by converting reported charges to cost using the 2010 all-payer inpatient cost-to-charge ratio for all hospitals in the NIS database. Cost was modeled via a log-gamma model in a generalized linear mixed model to account for potential correlation in cost within states and hospitals in the NIS database. Patients' characteristics and hospital factors were included in the model as fixed effects, while state and hospital were included as random effects. The national incidence of EGS was calculated from NIS data, and the US Census Bureau population projections were used to estimate incidence for 2010 to 2060. Nationwide costs were obtained by multiplying projected incidences by estimated costs and reported in year 2010 US dollar value. Nationwide, there were 2,640,725 adult EGS hospitalizations in 2010. The national average adjusted cost per EGS hospitalization was $10,744 (95% confidence interval [CI], $10,615-$10,874); applying these cost data to the national EGS hospitalizations gave a total estimated cost of $28.37 billion (95% CI, $28.03-$28.72 billion). Older age groups accounted for greater proportions of the cost ($8.03 billion for age ≥ 75 years, compared with $1.08 billion for age 18-24 years). As the US population continues to both grow and age, EGS costs are projected to increase by 45% to $41.20 billion (95% CI, $40.70-$41.7 billion) by 2060. EGS constitutes a significant portion of US health

  5. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer.

    Science.gov (United States)

    Søreide, K; Thorsen, K; Søreide, J A

    2014-01-01

    Perforated peptic ulcer (PPU) is a common surgical emergency that carries high mortality and morbidity rates. Globally, one-quarter of a million people die from peptic ulcer disease each year. Strategies to improve outcomes are needed. PubMed was searched for evidence related to the surgical treatment of patients with PPU. The clinical registries of trials were examined for other available or ongoing studies. Randomized clinical trials (RCTs), systematic reviews and meta-analyses were preferred. Deaths from peptic ulcer disease eclipse those of several other common emergencies. The reported incidence of PPU is 3.8-14 per 100,000 and the mortality rate is 10-25 per cent. The possibility of non-operative management has been assessed in one small RCT of 83 patients, with success in 29 (73 per cent) of 40, and only in patients aged less than 70 years. Adherence to a perioperative sepsis protocol decreased mortality in a cohort study, with a relative risk (RR) reduction of 0.63 (95 per cent confidence interval (c.i.) 0.41 to 0.97). Based on meta-analysis of three RCTs (315 patients), laparoscopic and open surgery for PPU are equivalent, but patient selection remains a challenge. Eradication of Helicobacter pylori after surgical repair of PPI reduces both the short-term (RR 2.97, 95 per cent c.i. 1.06 to 8.29) and 1-year (RR 1.49, 1.10 to 2.03) risk of ulcer recurrence. Mortality and morbidity from PPU can be reduced by adherence to perioperative strategies. © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  6. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery.

    Science.gov (United States)

    Bala, Miklosh; Kashuk, Jeffry; Moore, Ernest E; Kluger, Yoram; Biffl, Walter; Gomes, Carlos Augusto; Ben-Ishay, Offir; Rubinstein, Chen; Balogh, Zsolt J; Civil, Ian; Coccolini, Federico; Leppaniemi, Ari; Peitzman, Andrew; Ansaloni, Luca; Sugrue, Michael; Sartelli, Massimo; Di Saverio, Salomone; Fraga, Gustavo P; Catena, Fausto

    2017-01-01

    Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and practical recommendations for diagnosis and treatment of AMI. This review will address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure.

  7. Fluorescence-guided surgery and intervention - An AAPM emerging technology blue paper.

    Science.gov (United States)

    Pogue, Brian W; Zhu, Timothy C; Ntziachristos, Vasilis; Paulsen, Keith D; Wilson, Brian C; Pfefer, Joshua; Nordstrom, Robert J; Litorja, Maritoni; Wabnitz, Heidrun; Chen, Yu; Gioux, Sylvain; Tromberg, Bruce J; Yodh, Arjun G

    2018-04-10

    Fluorescence-guided surgery (FGS) and other interventions are rapidly evolving as a class of technologically driven interventional approaches in which many surgical specialties visualize fluorescent molecular tracers or biomarkers through associated cameras or oculars to guide clinical decisions on pathological lesion detection and excision/ablation. The technology has been commercialized for some specific applications, but also presents technical challenges unique to optical imaging that could confound the utility of some interventional procedures where real-time decisions must be made. Accordingly, the AAPM has initiated the publication of this Blue Paper of The Emerging Technology Working Group (TETAWG) and the creation of a Task Group from the Therapy Physics Committee within the Treatment Delivery Subcommittee. In describing the relevant issues, this document outlines the key parameters, stakeholders, impacts, and outcomes of clinical FGS technology and its applications. The presentation is not intended to be conclusive, but rather to inform the field of medical physics and stimulate the discussions needed in the field with respect to a seemingly low-risk imaging technology that has high potential for significant therapeutic impact. This AAPM Task Group is working toward consensus around guidelines and standards for advancing the field safely and effectively. © 2018 American Association of Physicists in Medicine.

  8. Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study

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    Scholten Pieter

    2007-07-01

    Full Text Available Abstract Background Acute left-sided colonic obstruction is most often caused by malignancy and the surgical treatment is associated with a high mortality and morbidity rate. Moreover, these operated patients end up with a temporary or permanent stoma. Initial insertion of an enteral stent to decompress the obstructed colon, allowing for surgery to be performed electively, is gaining popularity. In uncontrolled studies stent placement before elective surgery has been suggested to decrease mortality, morbidity and number of colostomies. However stent perforation can lead to peritoneal tumor spill, changing a potentially curable disease in an incurable one. Therefore it is of paramount importance to compare the outcomes of colonic stenting followed by elective surgery with emergency surgery for the management of acute left-sided malignant colonic obstruction in a randomized multicenter fashion. Methods/design Patients with acute left-sided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery (current standard treatment or colonic stenting as bridge to elective surgery. Outcome measurements are effectiveness and costs of both strategies. Effectiveness will be evaluated in terms of quality of life, morbidity and mortality. Quality of life will be measured with standardized questionnaires (EORTC QLQ-C30, EORTC QLQ-CR38, EQ-5D and EQ-VAS. Morbidity is defined as every event leading to hospital admission or prolonging hospital stay. Mortality will be analyzed as total mortality as well as procedure-related mortality. The total costs of treatment will be evaluated by counting volumes and calculating unit prices. Including 120 patients on a 1:1 basis will have 80% power to detect an effect size of 0.5 on the EORTC QLQ-C30 global health scale, using a two group t-test with a 0.05 two-sided significance level. Differences in quality of life and morbidity will be analyzed using mixed-models repeated measures

  9. Evaluation of the Effect of a Preoperative Single Dose of Gabapentin on Emergence Agitation in Patients Undergoing Breast Cancer Surgery

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    Simin Azemati

    2013-10-01

    Full Text Available Background: Emergence agitation is a transient confusional state that usuallyoccurs within 10 to 30 minutes of recovery from general anesthesia. It may lead to seriousconsequences and increasing hospital costs. This study evaluates the effect of gabapentinon emergence agitation in patients undergoing breast cancer surgery.Methods: This randomized, double blind controlled trial enrolled 100 femalepatients with American Society of Anesthesiologists' classifications I and II who werecandidates for breast cancer surgery. Patients were randomly assigned into two groups(n=50 that received either oral gabapentin 600 mg or placebo. Induction andmaintenance of anesthesia were similar in both groups. At the end of surgery, patient'sagitation score, pain score, and presence of nausea or vomiting were reported. In theward, the presence of headache or dizziness was checked during the first 8 h. Mann-Whitney test was used for comparison of agitation and pain scores between two groups.Chi-square test was used for comparing occurrence of nausea, vomiting and qualitative.The qualitative demographic variable and t-test compared quantitative demographicvariables.Results: There was a significantly lower incidence of emergence agitation in thegabapentin group before (P<0.001 and after (P=0.029 extubation. There weresignificantly lower mean agitation scores before (P<001 and after (P=0.006 extubationand in the pain score (P=0.005 in the gabapentin group. The need for remifentanilinfusion (P<0.05 during surgery was significantly lower in the gabapentin groupcompared with the placebo group. Occurrence of nausea and vomiting and gabapentinside effects that included headache or dizziness did not significantly differ between twogroups (P=0.126, P=1, P=0.629 respectively.Conclusion: Gabapentin not only decreased postoperative pain but also effectivelyreduced emergence agitation without any significant side effects in patients undergoingbreast cancer surgery.

  10. Impact of Targeted Preoperative Optimization on Clinical Outcome in Emergency Abdominal Surgeries: A Prospective Randomized Trial.

    Science.gov (United States)

    Sethi, Ashish; Debbarma, Miltan; Narang, Neeraj; Saxena, Anudeep; Mahobia, Mamta; Tomar, Gaurav Singh

    2018-01-01

    Perforation peritonitis continues to be one of the most common surgical emergencies that need a surgical intervention most of the times. Anesthesiologists are invariably involved in managing such cases efficiently in perioperative period. The assessment and evaluation of Acute Physiology and Chronic Health Evaluation II (APACHE II) score at presentation and 24 h after goal-directed optimization, administration of empirical broad-spectrum antibiotics, and definitive source control postoperatively. Outcome assessment in terms of duration of hospital stay and mortality in with or without optimization was also measured. It is a prospective, randomized, double-blind controlled study in hospital setting. One hundred and one patients aged ≥18 years, of the American Society of Anesthesiologists physical Status I and II (E) with clinical diagnosis of perforation peritonitis posted for surgery were enrolled. Enrolled patients were randomly divided into two groups. Group A is optimized by goal-directed optimization protocol in the preoperative holding room by anesthesiology residents whereas in Group S, managed by surgery residents in the surgical wards without any fixed algorithm. The assessment of APACHE II score was done as a first step on admission and 24 h postoperatively. Duration of hospital stay and mortality in both the groups were also measured and compared. Categorical data are presented as frequency counts (percent) and compared using the Chi-square or Fisher's exact test. The statistical significance for categorical variables was determined by Chi-square analysis. For continuous variables, a two-sample t -test was applied. The mean APACHE II score on admission in case and control groups was comparable. Significant lowering of serial scores in case group was observed as compared to control group ( P = 0.02). There was a significant lowering of mean duration of hospital stay seen in case group (9.8 ± 1.7 days) as compared to control group ( P = 0

  11. Socioeconomic factors and mortality in emergency general surgery: trends over a 20-year period.

    Science.gov (United States)

    Armenia, Sarah J; Pentakota, Sri Ram; Merchant, Aziz M

    2017-05-15

    Socioeconomic factors such as race, insurance, and income quartiles have been identified as independent risk factors in emergency general surgery (EGS), but this impact has not been studied over time. We sought to identify trends in disparities in EGS-related operative mortality over a 20-y period. The National Inpatient Sample was used to identify patient encounters coded for EGS in 1993, 2003, and 2013. Logistic regression models were used to examine the adjusted relationship between race, primary payer status, and median income quartiles and in-hospital mortality after adjusting for patients' age, gender, Elixhauser comorbidity score, and hospital region, size, and location-cum-teaching status. We identified 391,040 patient encounters. In 1993, Black race was associated with higher odds of in-hospital mortality (odds ratio [95% confidence interval]: 1.35 [1.20-1.53]) than White race, although this difference dissipated in subsequent years. Medicare, Medicaid, and underinsured patients had a higher odds of mortality than those with private insurance for the entire 20-y period; only the disparity in the underinsured decreased over time (1993, 1.63 [1.35-1.98]; 2013, 1.41 [1.20-1.67]). In 2003 (1.23 [1.10-1.38]) and 2013 (1.23 [1.11-1.37]), patients from the lowest income quartile were more likely to die after EGS than patients from the highest income quartile. Socioeconomic disparities in EGS-related operative morality followed inconsistent trends. Over time, while gaps in in-hospital mortality among Blacks and Whites have narrowed, disparities among patients belonging to lowest income quartile have worsened. Medicare and Medicaid beneficiaries continued to experience higher odds of in-hospital mortality relative to those with private insurance. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Emerging technologies in coloproctology: results of the Italian Society of Colorectal Surgery Logbook of Adverse Events.

    Science.gov (United States)

    Basso, L; Pescatori, M; La Torre, F; Destefano, I; Pulvirenti D'Urso, A; Infantino, A; Amato, A

    2013-04-01

    The aim of this paper is to present the results of the Italian Society of Colorectal Surgery [or Società Italiana di Chirurgia Colorettale (SICCR)] Logbook of adverse events (AE) occurring in relation to emerging technologies in coloproctology (ETCs), over a 3-year period. A total of 245 AE were reported (patients age: mean = 49.6 years, range = 20-75 years; gender: 155 = F, 90 = M). The "observations" originated from the same institution of the AEs in 44 cases (18.0%), while 201 patients (82.0%) had been operated on somewhere else. The three most reported ETCs were: Procedure for prolapsed haemorrhoids (PPH) (n = 120-48.9%), stapled transanal rectal resection (STARR (n = 96-39.2%), and transanal haemorrhoidal dearterialization (THD) (n = 11-4.5%). PPH, STARR, and THD together accounted for n = 227 (92.6%) observations. For the three main reported ETCs, the various AEs are listed. Chronic pain after PPH was 46/120 (38.3%), and after STARR of 21/96 (21.9%). The overall re-operation rate was n = 135 (55.1%) versus n = 110 (44.9%) no reoperation. In particular, for the three main reported ETCs, n = 68/120 (56.7%) following an AE after PPH, n = 47/94 (50.0%) following an AE after STARR, and n = 6/11 (54.5) following an AE post-THD. The various types of treatment to solve AE after each of the three most observed ETCs are reported in the text. Our results do not allow us to draw statistical conclusions; however, this was not the aim of our survey. ETCs are important, yet they are not without major risks. Manufacturers should help colorectal surgeons to convey the right message to patients.

  13. Surgical management of acutely presenting gastrointestinal stromal tumors of the stomach among elderly: experience of an emergency surgery department.

    Science.gov (United States)

    Marano, Luigi; Arru, Giovanni Maria Antonio; Piras, Mario; Fiume, Stefania; Gemini, Sergio

    2014-01-01

    The incidence of gastrointestinal stromal tumors (GISTs), requiring often an emergency surgical management, is extremely rare among elderly. We aimed to present the experience of the Emergency Surgery Department, Brotzu Hospital, in the management of elderly patients with GIST related emergencies. This study was carried out on 12 patients with gastrointestinal stromal tumors who presented to in an emergency situation during the period from January 2010 to December 2013. All patients' data, clinical presentations, surgical procedures, complications, and survival data were collected and analyzed. Between 2010 and 2013, 12 patients (8 males and 4 females), with a mean age of 70 years (range: 65-79 years) were admitted with different emergency presentations of clinically and radiologically suspected GISTs. The incidence of proximal obstruction was 41.7% of all gastric GIST cases, resulting acute gastrointestinal bleeding and perforation in 41.7% and 16.6% respectively. The mean length of hospitalization was 9.1 ± 2.3 days and there were no posterative complications or mortalities. At a mean follow-up of 21 months, 11 patients (91.6%) were alive and disease free. Although GISTs are uncommon among elderly, their incidence is increasing especially in their emergency presentation and surgeon should be prepared to treat this condition following the principles of GIST surgery as stated by the GIST consensus conference. In conclusion our data demonstrate that age itself does not affect the outcome of surgical treatment of GISTs in emergency situation. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  14. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  15. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  16. Hematological Disorders following Gastric Bypass Surgery: Emerging Concepts of the Interplay between Nutritional Deficiency and Inflammation

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    Mingyi Chen

    2013-01-01

    Full Text Available Obesity and the associated metabolic syndrome are among the most common and detrimental metabolic diseases of the modern era, affecting over 50% of the adult population in the United States. Surgeries designed to promote weight loss, known as bariatric surgery, typically involve a gastric bypass procedure and have shown high success rates for treating morbid obesity. However, following gastric bypass surgery, many patients develop chronic anemia, most commonly due to iron deficiency. Deficiencies of vitamins B1, B12, folate, A, K, D, and E and copper have also been reported after surgery. Copper deficiency can cause hematological abnormalities with or without neurological complications. Despite oral supplementation and normal serum concentrations of iron, copper, folate, and vitamin B12, some patients present with persistent anemia after surgery. The evaluation of hematologic disorders after gastric bypass surgery must take into account issues unique to the postsurgery setting that influence the development of anemia and other cytopenias. In this paper, the clinical characteristics and differential diagnosis of the hematological disorders associated with gastric bypass surgery are reviewed, and the underlying molecular mechanisms are discussed.

  17. The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

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    Rachel Gooden

    2014-12-01

    Full Text Available Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145 children were included, with emergence delirium occurring in 28 (19.3%. Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8% children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001. Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6 and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0. Complications of emergence delirium included intravenous line removal (n = 1, and surgical site bleeding (n = 3. Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

  18. Comparison between sevoflurane and desflurane on emergence and recovery characteristics of children undergoing surgery for spinal dysraphism

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    Priyanka Gupta

    2015-01-01

    Full Text Available Background and Aims: Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological evaluation and prompt management of complications. Studies have been rare comparing the recovery characteristics in paediatric neurosurgical patients. Hence, this study was carried out to compare the effect of sevoflurane and desflurane anaesthesia on emergence and extubation in children undergoing spinal surgery. Methods: Sixty children, aged 1-12 years, undergoing elective surgery for lumbo-sacral spinal dysraphism were enrolled. Anaesthesia was induced with sevoflurane using a face mask. The children were then randomised to receive either sevoflurane or desflurane with oxygen and nitrous oxide, fentanyl (1 μg/kg/h and rocuronium. The anaesthetic depth was guided by bispectral index (BIS ® monitoring with a target BIS ® between 45 and 55. Perioperative data with regard to demographic profile, haemodynamics, emergence and extubation times, modified Aldrete score (MAS, pain (objective pain score, agitation (Cole′s agitation score, time to first analgesic and complications, thereof, were recorded. Statistical analysis was done using STATA 11.2 (StataCorp., College Station, TX, USA and data are presented as median (range or mean ± standard deviation. Results: The demographic profile, haemodynamics, MAS, pain and agitation scores and time to first analgesic were comparable in between the two groups (P > 0.05. The emergence time was shorter in desflurane group (2.75 [0.85-12] min as compared to sevoflurane (8 [2.5-14] min (P < 0.0001. The extubation time was also shorter in desflurane group (3 [0.8-10] min as compared to the sevoflurane group (5.5 [1.2-14] min (P = 0.0003. Conclusion: Desflurane provided earlier tracheal extubation and emergence as compared to sevoflurane in children undergoing surgery for lumbo-sacral spinal dysraphism.

  19. Intraoperative seizures and seizures outcome in patients underwent awake craniotomy.

    Science.gov (United States)

    Yuan, Yang; Peizhi, Zhou; Xiang, Wang; Yanhui, Liu; Ruofei, Liang; Shu, Jiang; Qing, Mao

    2016-11-25

    Awake craniotomies (AC) could reduce neurological deficits compared with patients under general anesthesia, however, intraoperative seizure is a major reason causing awake surgery failure. The purpose of the study was to give a comprehensive overview the published articles focused on seizure incidence in awake craniotomy. Bibliographic searches of the EMBASE, MEDLINE,were performed to identify articles and conference abstracts that investigated the intraoperative seizure frequency of patients underwent AC. Twenty-five studies were included in this meta-analysis. Among the 25 included studies, one was randomized controlled trials and 5 of them were comparable studies. The pooled data suggested the general intraoperative seizure(IOS) rate for patients with AC was 8%(fixed effect model), sub-group analysis identified IOS rate for glioma patients was 8% and low grade patients was 10%. The pooled data showed early seizure rates of AC patients was 11% and late seizure rates was 35%. This systematic review and meta-analysis shows that awake craniotomy is a safe technique with relatively low intraoperative seizure occurrence. However, few RCTs were available, and the acquisition of further evidence through high-quality RCTs is highly recommended.

  20. Bilateral transversus abdominis plane block as a sole anesthetic technique in emergency surgery for perforative peritonitis in a high risk patient

    OpenAIRE

    Mishra, Lipi; Pani, Nibedita; Mishra, Debasis; Patel, Nupur

    2013-01-01

    Although transversus abdominis plane (TAP) block is an effective way of providing analgesia in post-operative abdominal surgery patients; however, it can be considered as an anesthetic technique in high-risk cases for surgery. We report a case of a geriatric female with chronic obstructive pulmonary disease in the respiratory failure, hypotension, posted in an emergency with old perforation leading to peritonitis. The surgery was successfully conducted under bilateral TAP block, which was use...

  1. Future of uniportal video-assisted thoracoscopic surgery-emerging technology.

    Science.gov (United States)

    Li, Zheng; Ng, Calvin S H

    2016-03-01

    Uniportal VATS poses unique difficulties to the surgeon, mainly as a consequence of operating through a small single incision. The instruments in uniportal VATS have limited movement through the small incision. In addition, the approach to the surgical operating site is unidirectional, which may restrict vision and retraction, and unavoidably suffers from instrument fencing. Recent thoracoscopic technology in the form of a wide variable angled lens has to some extent improved these shortcomings. The development of an extendable flexible thoracoscope and wireless steerable endoscope (WSE) systems can further improve the visualization for surgery and reduce or even remove fencing between endoscope and instruments. New single incision access platforms both derived from Natural orifice transluminal endoscopic surgery (NOTES) and robotic surgery approaches are on the horizon. These may allow uniportal VATS to be performed through an even smaller ultra-minimally invasive incision, with improved vision, more freedom of movement of the instruments and greater precision. However, a number of problems remain to be resolved, including provision of a stable platform and payload, applied force limitations and equipment sterilization. Advances in uniportal VATS major lung resection techniques have not only challenged the surgeon to acquire new skills and knowledge, but at the same time have rekindled the collaborative spirit between industry and clinician in developing novel equipment and technology to push the boundaries of minimally invasive surgery. These technological improvements and innovations may improve operating efficiency and safety during uniportal VATS surgery.

  2. Robotic surgery

    Science.gov (United States)

    ... with this type of surgery give it some advantages over standard endoscopic techniques. The surgeon can make ... Elsevier Saunders; 2015:chap 87. Muller CL, Fried GM. Emerging technology in surgery: Informatics, electronics, robotics. In: ...

  3. Dexmedetomidine versus labetalol infusions for controlling emergence hypertension in cranial surgeries for supratentorial tumors

    Directory of Open Access Journals (Sweden)

    Tarek Ahmed Mostafa Radwan

    2016-10-01

    Conclusion: Both dexmedetomidine and labetalol had favorable effects on hemodynamics at time of emergence from anesthesia in comparison with control group without prolongation of the time of extubation.

  4. Eye Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of retinal detachment, a ...

  5. Exposure in emergency general surgery in a time-based residency ...

    African Journals Online (AJOL)

    Objective: This paper aimed to characterize the resident exposure to acute general surgical conditions during a three-months rotation in a general surgical unit. Setting: The Department of Surgery, University of Nairobi and Kenyatta National Referral and Teaching Hospital in Nairobi. MethodS: Four residents (in their first to ...

  6. Revision surgery due to magnet dislocation in cochlear implant patients: an emerging complication.

    Science.gov (United States)

    Hassepass, Frederike; Stabenau, Vanessa; Maier, Wolfgang; Arndt, Susan; Laszig, Roland; Beck, Rainer; Aschendorff, Antje

    2014-01-01

    To analyze the cause and effect of magnet dislocation in cochlear implant (CI) recipients requiring magnet revision surgery for treatment. Retrospective study. Tertiary referral center. Case reports from 1,706 CI recipients consecutively implanted from January 2000 to December 2011 were reviewed. The number of cases requiring magnet revision surgery was assessed. Revision surgery involving magnet removal or replacement was indicated in 1.23% (21/1,706), of all CI recipients. Magnet dislocation occurring during magnetic resonance tomography (MRI), at 1.5 Tesla (T), with the magnet in place and with the application of compression bandaging around the head, was the main cause for revision surgery in 47.62% (10/21) of the affected cases. All 10 cases were implanted with Cochlear Nucleus cochlear implants. These events occurred, despite adherence to current recommendations of the manufacturer. The present study underlines that MRI examination is the main cause of magnet dislocation. The use of compressive bandaging when using 1.5-T MRI does not eliminate the risk of magnet dislocation. Additional cautionary measures are for required for conditional MRI. We recommend X-ray examination after MRI to determine magnet dislocation and avoid major complications in all cases reporting pain during or after MRI. Additional research regarding silicon magnet pocket design for added retention is needed. Effective communication of guidelines for precautionary measures during MRI examination in CI patients is mandatory for all clinicians involved. MRI in CI recipients should be indicated with caution.

  7. Bilateral transversus abdominis plane block as a sole anesthetic technique in emergency surgery for perforative peritonitis in a high risk patient

    Directory of Open Access Journals (Sweden)

    Lipi Mishra

    2013-01-01

    Full Text Available Although transversus abdominis plane (TAP block is an effective way of providing analgesia in post-operative abdominal surgery patients; however, it can be considered as an anesthetic technique in high-risk cases for surgery. We report a case of a geriatric female with chronic obstructive pulmonary disease in the respiratory failure, hypotension, posted in an emergency with old perforation leading to peritonitis. The surgery was successfully conducted under bilateral TAP block, which was used as a sole anesthetic technique. TAP block can be considered as an anesthetic technique for abdominal surgery in moribund patients.

  8. Emerging role of functional brain MRI in low-grade glioma surgery

    DEFF Research Database (Denmark)

    Friismose, Ancuta; Traise, Peter; Markovic, Ljubo

    Learning objectives 1. To describe the use of functional MRI (fMRI) in cranial surgery planning for patients with low-grade gliomas (LGG). 2. To show the increasing importance of fMRI in the clinical setting. Background LGG include brain tumors classified by the World Health Organization as grade I...... be used to map eloquent cortex areas, thus minimizing postoperative deficits and improving surgical performance. Findings and procedure details Patients diagnosed with low-grade gliomas located in eloquent brain areas undergo fMRI prior to surgery. The exams are performed on a 3T MR system (Achieva TX....... Language comprehension and visual tasks can be added to visualize Wernicke’s area or the visual cortex. Diffusion tensor imaging (DTI) is used to map nerve tract course relative to the tumour. Conclusion FMRI has proven its clinical utility in locating eloquent brain areas with relation to tumor site...

  9. Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes.

    Science.gov (United States)

    Mpirimbanyi, Christophe; Nyirimodoka, Alexandre; Lin, Yihan; Hedt-Gauthier, Bethany L; Odhiambo, Jackline; Nkurunziza, Theoneste; Havens, Joaquim M; Omondi, Jack; Rwamasirabo, Emile; Ntirenganya, Faustin; Toma, Gabriel; Mubiligi, Joel; Bayitondere, Scheilla; Riviello, Robert

    2017-12-01

    Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda. This retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes. In 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15-60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients.

  10. [Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

    Science.gov (United States)

    Lin, Luo; Yueming, Zhang; Meisheng, Li; Jiexue, Wang; Yang, Ji

    2017-12-01

    To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (Pgeneral anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

  11. Avaliação dos níveis basais de FSH em pacientes inférteis com endometriose profunda de ovário tratadas cirurgicamente Evaluation of basal FSH serum levels in infertile patients with deep ovarian endometriosis who underwent surgery

    Directory of Open Access Journals (Sweden)

    Sandra Frankfurt

    2009-07-01

    Full Text Available OBJETIVO: avaliar a reserva ovariana de pacientes inférteis portadoras de endometriose profunda de ovário, submetidas à cirurgia excisional dos endometriomas, atendidas entre os meses de Fevereiro e Novembro de 2008. MÉTODOS: estudo prospectivo que incluiu 30 pacientes portadoras de endometriose graus III e IV com comprometimento profundo de ovário submetidas à cirurgia excisional dos endometriomas e 30 pacientes portadoras de endometriose graus I e II que foram alocadas como Grupo Controle. A reserva ovariana foi avaliada indiretamente a partir do valor do hormônio folículo estimulante (FSH basal (U/L, entre o terceiro e quinto dias do ciclo, após um período de 12 meses da cirurgia. O índice de massa corpórea (IMC foi calculado conforme a fórmula de Quetelet [peso (kg/estatura (cm²]. Para a comparação das variáveis "idade", "IMC" e "valores de FSH basal" entre os grupos, foi utilizado o teste não paramétrico U de Mann-Whitney. RESULTADOS: não foi encontrada diferença significativa entre os grupos em relação à idade e ao IMC. Em relação ao FSH basal, observou-se que, no grupo das pacientes com endometriose profunda, o valor médio foi de 7,0 U/L, enquanto que, no Grupo Controle, foi de 5,6 U/L (p=0,3, o que demonstra que a diferença no valor médio de FSH encontrado nos dois grupos não foi significativa. CONCLUSÕES: a cirurgia não influenciou de forma deletéria a reserva ovariana das pacientes com endometriose profunda de ovário.PURPOSE: to evaluate the ovarian reserve of infertile patients with severe ovarian endrometriosis, submitted to excisional surgery of endometriomas and attended from February to November, 2008. METHODS: prospective study, including 30 patients with endometriosis grades III and IV, with severe ovarian impairment, submitted to excisional surgery of the endometriomas, and 30 patients with endometriosis grades I and II, allocated as a Control Group. The ovarian reserve was indirectly assessed

  12. Postanesthetic Emergence Agitation in Pediatric Patients under General Anesthesia

    OpenAIRE

    Mohkamkar, Masoumeh; Farhoudi, Fatemeh; Alam-Sahebpour, Alireza; Mousavi, Seyed-Abdullah; Khani, Soghra; Shahmohammadi, Soheila

    2014-01-01

    Abstract Objective Postanesthetic emergence agitation is a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This study was done to determine the prevalence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. Methods This cross-sectional descriptive and analytic study was performed on 747 pediatric patients aged 3- 7 years that underwent general anesthesia for various elective surgeries at Bou-...

  13. The effect of ketamine on the separation anxiety and emergence agitation in children undergoing brief ophthalmic surgery under desflurane general anesthesia

    OpenAIRE

    Jeong, Won Ju; Kim, Woon Young; Moon, Man Gook; Min, Doo Jae; Lee, Yoon Sook; Kim, Jae Hwan; Park, Young Cheol

    2012-01-01

    Background Emergence agitation (EA) frequently occurs after desflurane anesthesia in children. Ketamine, because of its sedative and analgesic properties, might be useful for the management of separation anxiety and EA. We investigated the preventive effect of ketamine on separation anxiety and EA after desflurane anesthesia in children for brief ophthalmic surgery. Methods Sixty children, ranging in age from 2-8 years old, undergoing brief ophthalmic surgery were randomly allocated to one of...

  14. Safe introduction of new procedures and emerging technologies in surgery: education, credentialing, and privileging.

    Science.gov (United States)

    Sachdeva, Ajit K; Russell, Thomas R

    2007-08-01

    Ongoing horizon scanning is needed to identify new procedures and emerging technologies that should be evaluated for introduction into surgical practice. Following evidence-based evaluation, if a new modality is found ready for adoption in practice, surgeons need education in the safe and effective use of the new modality. The educational experience should include structured teaching and learning, verification of new knowledge and skills, preceptoring or proctoring, and monitoring of outcomes. Credentialing and privileging to perform a new procedure or use an emerging technology should be based on evaluation of knowledge and skills and outcomes of surgical care, and not merely on the numbers of procedures performed. Education of the surgical team is also essential. The entire process involving education, verification of knowledge and skills, credentialing, and privileging must be transparent. Patients need to play a central role in making informed decisions regarding their care that involves use of a new procedure or an emerging technology, and they should participate actively in their perioperative care.

  15. Obesity and contraception: metabolic changes, risk of thromboembolism, use of emergency contraceptives, and role of bariatric surgery.

    Science.gov (United States)

    Gurney, E P; Murthy, A S

    2013-06-01

    Rates of obesity are increasing worldwide. Due to the medical consequences of obesity, routine health care like family planning becomes complicated. Conflicting data exists regarding efficacy of hormonal contraceptives in obese women, while little data on efficacy of emergency contraception in obese women exists. Much of what is available suggests lower serum hormonal levels in obese women with little effect on ovulation inhibition. Contraceptive steroids can cause a number of deteriorating metabolic changes, particularly in obese women; whether these changes are clinically significant is unknown. Venous thromboembolic risk is increased with both obesity and use of hormonal contraceptives; however the question remains if the risk is additive or multiplicative. Bariatric surgery can lead to digestive changes which may affect absorption of contraceptive hormones. While long acting reversible contraceptives may be the best option in the post operative obese patient, little data, beyond a simple recommendation to avoid pregnancy for at least one year, exists to help guide appropriate contraceptive choice.

  16. Patient Decision-Making About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives.

    Science.gov (United States)

    Dibley, Lesley; Czuber-Dochan, Wladyslawa; Wade, Tiffany; Duncan, Julie; Burch, Jennie; Warusavitarne, Janindra; Norton, Christine; Artom, Micol; O'Sullivan, Liam; Verjee, Azmina; Cann, Denise

    2018-01-18

    Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes. We purposively recruited participants with IBD from UK hospital outpatient and community sources, and IBD clinicians from public hospitals. Four focus groups, 29 semistructured patient participant interviews, and 18 clinician interviews were audio recorded, transcribed, and analysed thematically. Participants had a current temporary, recently-reversed, or permanent stoma, or were stoma naive. Four themes emerged: Preoperative concerns and expectations, Patient decision-making, Surgery and recovery, and Long-term outcomes. Participants and clinicians agreed about most preoperative concerns, that outcomes were often better than expected, and support from others with a stoma is beneficial. Patient decision-making involves multiple factors, including disease status. Some clinicians avoid discussing SFS, and the phrase 'last resort' can bias patient perceptions; others recommend early discussion, increasing dialogue when medical management becomes ineffective. The postoperative period is particularly challenging for patients. Stoma acceptance is influenced by personal perceptions and pre- and postoperative clinical and social support. Patients need balanced information on all treatment options, including surgery, from an early stage. Early multidisciplinary team dialogue about SFS, and contact with others living well with a stoma, could enable informed decision-making. Life with a stoma is often better than anticipated, improving quality of life and control. Ongoing specialist nursing support aids recovery and adjustment. © 2018 Crohn’s & Colitis Foundation of America. Published by Oxford University

  17. The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study.

    Science.gov (United States)

    McIsaac, Daniel I; Moloo, Husein; Bryson, Gregory L; van Walraven, Carl

    2017-05-01

    Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS. Our main exposure was preoperative frailty, as defined by the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. The Adjusted Clinical Groups frailty-defining diagnoses indicator is a binary variable that uses 12 clusters of frailty-defining diagnoses. Our main outcome measures were 1-year all-cause mortality (primary), intensive care unit admission, length of stay, institutional discharge, and costs of care (secondary). Of 77,184 patients, 19,779 (25.6%) were frail. Death within 1 year occurred in 6626 (33.5%) frail patients compared with 11,366 (19.8%) nonfrail patients. After adjustment for sociodemographic and surgical confounders, this resulted in a hazard ratio of 1.29 (95% confidence interval [CI] 1.25-1.33). The risk of death for frail patients varied significantly across the postoperative period and was particularly high immediately after surgery (hazard ratio on postoperative day 1 = 23.1, 95% CI 22.3-24.1). Frailty was adversely associated with all secondary outcomes, including a 5.82-fold increase in the adjusted odds of institutional discharge (95% CI 5.53-6.12). After EGS, frailty is associated with increased rates of mortality, institutional discharge, and resource use. Strategies that might improve perioperative outcomes in frail EGS patients need to be developed and tested.

  18. Lung Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at increased risk of sudden lung ...

  19. Robot-assisted surgery: an emerging platform for human neuroscience research

    Directory of Open Access Journals (Sweden)

    Anthony Michael Jarc

    2015-06-01

    Full Text Available Classic studies in human sensorimotor control use simplified tasks to uncover fundamental control strategies employed by the nervous system. Such simple tasks are critical for isolating specific features of motor, sensory, or cognitive processes, and for inferring causality between these features and observed behavioral changes. However, it remains unclear how these theories translate to complex sensorimotor tasks or to natural behaviors. Part of the difficulty in performing such experiments has been the lack of appropriate tools for measuring complex motor skills in real-world contexts. Robot-assisted surgery (RAS provides an opportunity to overcome these challenges by enabling unobtrusive measurements of user behavior. In addition, a continuum of tasks with varying complexity – from simple tasks such as those in classic studies to highly complex tasks such as a surgical procedure – can be studied using RAS platforms. Finally, RAS includes a diverse participant population of inexperienced users all the way to expert surgeons. In this perspective, we illustrate how the characteristics of RAS systems make them compelling platforms to extend many theories in human neuroscience, as well as, to develop new theories altogether.

  20. Managing hip fracture and lower limb surgery in the emergency setting: Potential role of non-vitamin K antagonist oral anticoagulants.

    Science.gov (United States)

    Fisher, William

    2017-06-01

    Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thrombo-embolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries. Non-vitamin K antagonist oral anticoagulants (NOACs) are indicated for VTE prevention after elective hip or knee replacement surgery, but at present are not widely recommended for other orthopedic indications despite their advantages over conventional anticoagulants and promising real-world evidence. In patients undergoing HFS or lower limb surgery, decisions on whether to anticoagulate and the most appropriate anti-coagulation strategy can be guided by weighing the risk of thromboprophylaxis against the benefit in relation to each patient's medical history and age. In addition, the nature and location of the fracture, operating times and times before fracture fixation should be considered. The current review discusses the need for anticoagulation in patients undergoing emergency HFS or lower limb surgery together with the current guidelines and available evidence on the use of NOACs in this setting. Appropriate thromboprophylactic strategies and practical advice on the peri-operative management of patients who present to the Emergency Department on a NOAC before emergency surgery are further outlined.

  1. Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions.

    Science.gov (United States)

    Faucheron, J-L; Paquette, B; Trilling, B; Heyd, B; Koch, S; Mantion, G

    2018-02-01

    Few studies compare management and outcomes of obstructive colonic cancer, depending on the tumor site. We aim to evaluate the differences in patient characteristics, tumor characteristics, and outcomes of emergency surgery for obstructive right-sided versus left-sided colonic cancers. Between 2000 and 2009, 71 consecutive patients had an emergency colectomy following strict and clear definition of obstruction in a single institution. We retrospectively analyzed pre, per, and postoperative data that were prospectively collected. There were 31 and 40 patients in the right and left group, respectively. Patients aged over 80 were more frequent in the right group (p = 0.03). At operation, ileocecal valve was less often competent in the right group (p = 0.03). The one-stage strategy was more frequent in the right group (p = 0.008). Patients in the right group had a higher rate of nodes invasion (p = 0.04). One- and two-year mortality rate in the right group had a tendency to be higher. Patients presenting with a right obstructive colonic cancer are older, have a more advanced locoregional disease, and are more often treated in a one-stage strategy than patients with a left obstructive tumor.

  2. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

    Directory of Open Access Journals (Sweden)

    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  3. Outcome after emergency surgery without angiography in patients with intracerebral haemorrhage after aneurysm rupture

    DEFF Research Database (Denmark)

    Bergdal, Ove; Springborg, Jacob; Hauerberg, John

    2009-01-01

    BACKGROUND: Patients with large intracerebral haematomas (ICH) from aneurysm rupture often present in a poor clinical condition and have a poor prognosis. Time delay for preoperative angiography might in some cases be unappealing. We evaluated the outcome after immediate haematoma removal...... and aneurysm occlusion without preoperative angiography. METHODS: We retrospectively identified 13 consecutive patients. We recorded clinical data and evaluated mortality and morbidity with the Glasgow Outcome Score (GOS) and Telephone Interview of Cognitive Status (TICS). FINDINGS: At follow up seven...... of thirteen patients had favourable outcome assessed by GOS. Three patients had severe disability and three patients died. None of the survived patients interviewed had impaired cognition. CONCLUSIONS: In patients presented in a critical state with aneurysmal ICH, emergency haematoma removal and aneurysm...

  4. Emergency Surgery in a Patient with Scleroderma - Anaesthetic Challenges: A Case Report

    Directory of Open Access Journals (Sweden)

    Teena Bansal

    2013-06-01

    Full Text Available Scleroderma (progressive systemic sclerosis is a multisystem disease involving the skin, airway, musculoskeletal, gastrointestinal, pulmonary, renal and cardiac systems that can pose a significant challenge for the anaesthetist. The multisystem involvement of scleroderma can impact on every aspect of anaesthetic care especially airway management. There are no specific contraindications to the use of any type of anaesthesia, although the selection must be guided by identification of organ dysfunction. The anaesthetist must be aware of the organs involved, the severity of the disease and the associated anaesthetic considerations and potential risks in order to safely & skilfully manage the patient with scleroderma. We hereby present a case report of a patient with scleroderma for emergency orbital decompression because of orbital cellulitis.

  5. Emergence from anesthesia in children undergoing ambulatory surgery- a comparison between propofol and sevoflurane using single anesthetic technique

    International Nuclear Information System (INIS)

    Pasha, A.K.; Kazi, W.A.; Farhat, K

    2013-01-01

    statistically significant. Conclusion: VIMA with sevoflurane provided quicker emergence and early recovery compared with TIVA with propofol, in children undergoing ambulatory surgery. (author)

  6. Socioeconomic outcome of epilepsy surgery: A controlled national study

    DEFF Research Database (Denmark)

    Jennum, Poul; Sabers, Anne; Christensen, Jakob

    2016-01-01

    severely affected by their disease as indicated by health care use and social impact before the surgical procedure. Patients who underwent epilepsy surgery had a significantly lower costs associated with the use of medication, outpatient services, inpatient admissions, and accident and emergency visits...... after surgery. The surgical intervention had no significant effects on social status in terms of occupation and educational level. CONCLUSION: Although epilepsy surgery was followed by a reduction in inpatient and outpatient health care use, medication and use of accident and emergency facilities...

  7. Prevention of Cerebral Embolism Progression by Emergency Surgery of the Left Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Syuichi Tetsuka

    2015-01-01

    Full Text Available A 21-year-old woman developed left hemiparesis during work and was hospitalized. Her National Institutes of Health Stroke Scale score was 4. Hyperintense areas in the left basal ganglia, corona radiata, and cortex of the temporal lobe were found by brain diffusion-weighted magnetic resonance imaging, indicating acute cerebral infarction. Echocardiography showed a giant mass of diameter 7 × 4 cm in the left atrium. Therefore, she was diagnosed with cerebral embolism due to a left atrial myxoma. Currently, thrombolytic therapy may continue to be effective because the embolic source may be composed of tumor tissue itself. In case of atrial myxoma, we considered that the use of tPA as emergency treatment in all patients with infarction by atrial myxoma may be questioned. Thus, cardiac tumor extraction was performed the next day after hospitalization without thrombolytic therapy. The excised myxoma measured 7 × 6 × 4 cm. The patient recovered and her neurological symptoms also improved. Furthermore, her National Institutes of Health Stroke Scale score improved to 0. Thirteen days after admission, the patient was discharged from our hospital. Cardiac myxoma is often associated with a high risk of embolic episodes, which emphasizes the need for prompt surgical excision as soon as the diagnosis is confirmed.

  8. Do instability markers predict satisfactory reduction and requirement for later surgery in emergency department patients with wrist fracture?

    Science.gov (United States)

    Winayak, Amar; Gossat, Alyza; Cooper, Jenny; Ritchie, Peter; Lim, Wei; Klim, Sharon; Kelly, Anne-Maree

    2018-02-01

    Research suggests that the presence of instability markers in patients with displaced distal radial fractures is associated with poorer outcome. Our aims were to determine whether the presence of previously defined instability markers could predict the likelihood of successful ED reduction and requirement for a secondary procedure after ED reduction. Retrospective cohort study performed by medical record review. Adult ED patients coded as having an isolated wrist fracture and having fracture reduction in ED were eligible for inclusion. Data collected included demographics, history of osteoporosis, mechanism of injury, radiological features on X-rays and performance of a secondary procedure. Outcomes of interest were the rate of successful fracture reduction in ED (against defined radiological criteria), the rate of secondary procedures and the association between the number of defined instability risk factors and successful reduction and performance of a secondary surgical procedure. Analysis was by χ 2 test, receiver operating characteristic curve, logistic regression analyses. Three hundred and nineteen patients were studied; median age 62 years, 77% female. Sixty-five per cent of patients had satisfactory fracture reduction in ED (95% CI 59%-70%). Eighty-six patients underwent a secondary procedure to reduce/stabilise their fracture (28%, 95% CI 23%-33%). Younger age, lack of satisfactory ED reduction and increased number of instability factors were independently predictive of the performance of a secondary procedure. Instability risk factors are common in patients with wrist fractures requiring reduction in ED. The number of instability factors is not a strong predictor of the performance of secondary procedures. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  9. Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery

    Directory of Open Access Journals (Sweden)

    Khattab Ahmed

    2009-01-01

    : Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced sevoflurane-related emergence agitation without delaying discharge.

  10. Comparing the Quality and Complications of Tube Thoracostomy by Emergency Medicine and Surgery Residents; a Cohort Study

    Directory of Open Access Journals (Sweden)

    Parvin Kashani

    2017-01-01

    Full Text Available Introduction: Tube thoracostomy complications depend on the operator’s skill, patients’ general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs and surgery residents (SRs.Methods: This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20.Results: 72 patients with the mean age of 37.1±14.1 years were studied (86.1% male. 23 (63.8% cases were complicated in SRs and 22 (61.1% cases in EMRs group (total= 62.5%. Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99, drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50, and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25 were among the most common observed complications. The overall odds ratio of complication development was 0.89 (95% CI: 0.35-2.25, p = 0.814 for SRs and 1.12 (95% CI: 0.28-4.53, p = 0.867 for EMRs.Conclusion: The findings of the present study showed no significant difference between SRs and EMRs regarding quality of tube thoracostomy placement and its subsequent complications for trauma patients. The rate of complications were interestingly high (>60% for both groups.

  11. Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion.

    Science.gov (United States)

    Safdie, Fernando M; Sanchez, Manuel Villa; Sarkaria, Inderpal S

    2017-01-01

    Video assisted thoracic surgery (VATS) has become a routinely utilized approach to complex procedures of the chest, such as pulmonary resection. It has been associated with decreased postoperative pain, shorter length of stay and lower incidence of complications such as pneumonia. Limitations to this modality may include limited exposure, lack of tactile feedback, and a two-dimensional view of the surgical field. Furthermore, the lack of an open incision may incur technical challenges in preventing and controlling operative misadventures leading to major hemorrhage or other intraoperative emergencies. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. Unplanned conversions for major intraoperative bleeding or airway injury during general thoracic surgical procedures are relatively rare and often can be avoided with careful preoperative planning, review of relevant imaging, and meticulous surgical technique. When these events occur, a pre-planned, methodical response with initial control of bleeding, assessment of injury, and appropriate repair and/or salvage procedures are necessary to maximize outcomes. The surgeon should be well versed in injury-specific incisions and approaches to maximize adequate exposure and when feasible, allow completion of the index operation. Decisions to continue with a minimally invasive approach should consider the comfort and experience level of the surgeon with these techniques, and the relative benefit gained against the risk incurred to the patient. These algorithms may be expected to shift in the future with increasing sophistication and capabilities of minimally invasive technologies and approaches.

  12. Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery.

    Science.gov (United States)

    Blankush, Joseph M; Leitman, I Michael; Soleiman, Aron; Tran, Trung

    2016-09-01

    A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infections. Such infections increase morbidity, length of stay, and overall cost. This study evaluates the correlation between elevated pre-operative glycosylated hemoglobin (HbA1c) and post-operative infections. Adult patients undergoing non-emergent procedures across all surgical subspecialties from January 2010 to July 2014 had a preoperative HbA1c measured as part of their routine pre-surgical assessment. 2200 patient charts (1100 operative infection (superficial surgical site infection, deep wound/surgical space abscess, pneumonia, and/or urinary tract infection as defined by Centers for Disease Control criteria) within 30 days of surgery. Patients with HbA1c infection rate (3.8% in the HbA1c infection. Elevated HbA1c was, however, predictive of significantly increased risk of post-operative infection when associated with increased age (≥81 years of age) or dirty wounds. The risk factors of post-operative infection are multiple and likely synergistic. While pre-operative HbA1c level is not independently associated with risk of post-operative infection, there are scenarios and patient subgroups where pre-operative HbA1c is useful in predicting an increased risk of infectious complications in the post-operative period.

  13. Challenging a classic myth: pneumoperitoneum associated with acute diverticulitis is not an indication for open or laparoscopic emergency surgery in hemodynamically stable patients. A 10-year experience with a nonoperative treatment.

    Science.gov (United States)

    Costi, Renato; Cauchy, François; Le Bian, Alban; Honart, Jean-François; Creuze, Nicolas; Smadja, Claude

    2012-07-01

    In patients presenting with acute diverticulitis (AD) and signs of acute peritonitis, the presence of extradigestive air (EDA) on a computer tomography (CT) scan is often considered to indicate the need for emergency surgery. Although the traditional management of "perforated" AD is open sigmoidectomy, more recently, laparoscopic drainage/lavage (usually followed by delayed elective sigmoidectomy) has been reported. The aim of this retrospective study is to evaluate the results of nonoperative management of emergency patients presenting with AD and EDA. The outcomes of 39 consecutive hemodynamically stable patients (23 men, mean age = 54.7 years) who were admitted with AD and EDA and were managed nonoperatively (antibiotic and supportive treatment) at a tertiary-care university hospital between January 2001 and June 2010 were retrospectively collected and analyzed. These included morbidity (Clavien-Dindo) and treatment failure (need for emergency surgery or death). A univariate analysis of clinical, radiological, and laboratory criteria with respect to treatment failure was performed. Results of delayed elective laparoscopic sigmoidectomy were also analyzed. There was no mortality. Thirty-six of the 39 patients (92.3%) did not need surgery (7 patients required CT-guided abscess drainage). Mean hospital stay was 8.1 days. Duration of symptoms, previous antibiotic administration, severe sepsis, PCR level, WBC concentration, and the presence of abdominal collection were associated with treatment failure, whereas "distant" location of EDA and free abdominal fluid were not. Five patients had recurrence of AD and were treated medically. Seventeen patients (47.2%) underwent elective laparoscopic sigmoidectomy for which mean operative time was 246 min (range = 100-450) and the conversion rate was 11.8%. Mortality was nil and the morbidity rate was 41.2%. Mean postoperative stay was 7.1 days (range = 4-23). Nonoperative management is a viable option in most emergency

  14. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial: study protocol, rationale and feasibility of a randomised multicentre trial

    Directory of Open Access Journals (Sweden)

    Vester-Andersen Morten

    2013-02-01

    Full Text Available Abstract Background Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients. Methods and design The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. Discussion This trial evaluates the benefits and possible harm of intermediate care. The results may potentially influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care. Trial registration Clinicaltrials.gov identifier: NCT01209663

  15. Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization.

    Science.gov (United States)

    Göker, Ayşe Enise; Aydoğdu, İmran; Saltürk, Ziya; Berkiten, Güler; Atar, Yavuz; Kumral, Tolgar Lütfi; Uyar, Yavuz

    2017-01-01

    The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  16. Safety and Feasibility of a Ketamine Package to Support Emergency and Essential Surgery in Kenya when No Anesthetist is Available: An Analysis of 1216 Consecutive Operative Procedures.

    Science.gov (United States)

    Burke, Thomas F; Suarez, Sebastian; Sessler, Daniel I; Senay, Ayla; Yusufali, Taha; Masaki, Charles; Guha, Moytrayee; Rogo, Debora; Jani, Pankaj; Nelson, Brett D; Rogo, Khama

    2017-12-01

    Lack of access to emergency and essential surgery is widespread in low- and middle-income countries. Scarce anesthesia services contribute to this unmet need. The aim of this study was to evaluate the safety and feasibility of the Every Second Matters for Emergency and Essential Surgery-Ketamine (ESM-Ketamine) package for emergency and essential procedures when no anesthetist was available. From November 2013 to September 2017, the ESM-Ketamine package was used for patients requiring emergency or life-improving surgeries in fifteen selected facilities across Kenya when no anesthetist was available. A mixed-methods approach was used to assess safety and feasibility of the ESM-Ketamine package, including demand, acceptability, and practicality. The primary outcome was ketamine-related adverse events. Key-informant interviews captured perceptions of providers, hospital administrators, and surgeons/proceduralists. Non-anesthetist mid-level providers used ESM-Ketamine for 1216 surgical procedures across the fifteen study facilities. The median ketamine dose was 2.1 mg/kg. Brief (30 s) oxygen desaturations occurred in seven patients (0.6%). There were 157 (13%) reported cases of hallucinations and agitation which were treated with diazepam. All patients recovered uneventfully, and no ketamine-related deaths were reported. Twenty-seven key-informant interviews showed strong support for the program with four main themes: financial considerations, provision of services, staff impact, and scaling considerations. The ESM-Ketamine package appears safe and feasible and is capable of expanding access to emergency and essential surgeries in rural Kenya when no anesthetist is available.

  17. Physical activity in the elderly who underwent joint replacement surgery in the course of rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Agnieszka Prusinowska

    2016-07-01

    Full Text Available According to the forecasts of the Central Statistical Office of Poland, in 2030 people at the age of 65 and older will account for 23.8%, i.e. their number will amount to approx. 8.5 m people. Geriatric rheumatic patients more often decide to undergo surgical joint replacement. According to the National Health Fund, the number of joint replacement services provided in 2014 increased by 93%, as compared to 2005. Improving the physical performance of this constantly expanding group of patients requires taking into account many factors to raise their functional status, reduce the risk of falling, teach rules of proper functioning with an artificial joint and encourage unassisted physical activity. Restoring fitness and independence is a difficult but necessary task due to an increasing number of seniors with replaced joint.

  18. Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care.

    Science.gov (United States)

    Finnegan, Micaela A; Shaffer, Robyn; Remington, Austin; Kwong, Jereen; Curtin, Catherine; Hernandez-Boussard, Tina

    2017-06-21

    Major joint replacement surgical procedures are common, elective procedures with a care episode that includes both inpatient readmissions and postoperative emergency department (ED) visits. Inpatient readmissions are well studied; however, to our knowledge, little is known about ED visits following these procedures. We sought to characterize 30-day ED visits following a major joint replacement surgical procedure. We used administrative records from California, Florida, and New York, from 2010 through 2012, to identify adults undergoing total knee and hip arthroplasty. Factors associated with increased risk of an ED visit were estimated using hierarchical regression models controlling for patient variables with a fixed hospital effect. The main outcome was an ED visit within 30 days of discharge. Among the 152,783 patients who underwent major joint replacement, 5,229 (3.42%) returned to the inpatient setting and 8,883 (5.81%) presented to the ED for care within 30 days. Among ED visits, 17.94% had a primary diagnosis of pain and 25.75% had both a primary and/or a secondary diagnosis of pain. Patients presenting to the ED for subsequent care had more comorbidities and were more frequently non-white with public insurance relative to those not returning to the ED (p care insurance coverage expansions are uncertain; however, there are ongoing attempts to improve quality across the continuum of care. It is therefore essential to ensure that all patients, particularly vulnerable populations, receive appropriate postoperative care, including pain management. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  19. [A Distal Bile Duct Carcinoma Patient Who Underwent Surgical Resection for Liver Metastasis].

    Science.gov (United States)

    Komiyama, Sosuke; Izumiya, Yasuhito; Kimura, Yu; Nakashima, Shingo; Kin, Syuichi; Kawakami, Sadao

    2018-03-01

    A 70-year-old man with distal bile duct carcinoma underwent a subtotal stomach-preserving pancreaticoduodenectomy without adjuvant chemotherapy. One and a half years after the surgery, elevated levels of serum SPan-1(38.1 U/mL)were observed and CT scans demonstrated a solitary metastasis, 25mm in size, in segment 8 of the liver. The patient received 2 courses of gemcitabine-cisplatin combination chemotherapy. No new lesions were detected after chemotherapy and the patient underwent a partial liver resection of segment 8. The pathological examination revealed a metachronous distant metastasis originating from the bile duct carcinoma. Subsequently, the patient received S-1 adjuvant chemotherapy for 6 months. Following completion of all therapies, the patient survived without tumor recurrence for 3 years and 10 months after the initial operation. Thus, surgical interventions might be effective in improving prognosis among selected patients with postoperative liver metastasis of bile duct carcinoma.

  20. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

    Directory of Open Access Journals (Sweden)

    Mehmet Özülkü

    2015-08-01

    Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

  1. Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

    Science.gov (United States)

    Daniels, Alan H; Hart, Robert A; Hilibrand, Alan S; Fish, David E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Tortolani, P Justin; Stroh, D Alex; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective cohort study of prospectively collected data. To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of iatrogenic spinal cord injury. In total, 3 cases of iatrogenic spinal cord injury following cervical spine surgery were identified. Institutional incidence rates ranged from 0.0% to 0.24%. Of the 3 patients with quadriplegia, one underwent anterior-only surgery with 2-level cervical corpectomy, one underwent anterior surgery with corpectomy in addition to posterior surgery, and one underwent posterior decompression and fusion surgery alone. One patient had complete neurologic recovery, one partially recovered, and one did not recover motor function. Iatrogenic spinal cord injury following cervical spine surgery is a rare and devastating adverse event. No standard protocol exists that can guarantee prevention of this complication, and there is a lack of consensus regarding evaluation and treatment when it does occur. Emergent imaging with magnetic resonance imaging or computed tomography myelography to evaluate for compressive etiology or malpositioned instrumentation and avoidance of hypotension should be performed in cases of intraoperative and postoperative spinal cord injury.

  2. Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery

    Directory of Open Access Journals (Sweden)

    Wujun Geng

    2015-01-01

    Full Text Available Objective. Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Methods. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1 preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA pump, (2 preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Results. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL- 6 levels at 24 and 48 h after the operation. Conclusion. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery.

  3. Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery.

    Science.gov (United States)

    Geng, Wujun; Hong, Wandong; Wang, Junlu; Dai, Qinxue; Mo, Yunchang; Shi, Kejian; Sun, Jiehao; Qin, Jinling; Li, Mei; Tang, Hongli

    2015-01-01

    Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA) pump, (2) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3) 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL-) 6 levels at 24 and 48 h after the operation. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery.

  4. Emergency surgery data and documentation reporting forms for sudden-onset humanitarian crises, natural disasters and the existing burden of surgical disease.

    Science.gov (United States)

    Burkle, Frederick M; Nickerson, Jason W; von Schreeb, Johan; Redmond, Anthony D; McQueen, Kelly A; Norton, Ian; Roy, Nobhojit

    2012-12-01

    Following large-scale disasters and major complex emergencies, especially in resource-poor settings, emergency surgery is practiced by Foreign Medical Teams (FMTs) sent by governmental and non-governmental organizations (NGOs). These surgical experiences have not yielded an appropriate standardized collection of data and reporting to meet standards required by national authorities, the World Health Organization, and the Inter-Agency Standing Committee's Global Health Cluster. Utilizing the 2011 International Data Collection guidelines for surgery initiated by Médecins Sans Frontières, the authors of this paper developed an individual patient-centric form and an International Standard Reporting Template for Surgical Care to record data for victims of a disaster as well as the co-existing burden of surgical disease within the affected community. The data includes surgical patient outcomes and perioperative mortality, along with referrals for rehabilitation, mental health and psychosocial care. The purpose of the standard data format is fourfold: (1) to ensure that all surgical providers, especially from indigenous first responder teams and others performing emergency surgery, from national and international (Foreign) medical teams, contribute relevant and purposeful reporting; (2) to provide universally acceptable forms that meet the minimal needs of both national authorities and the Health Cluster; (3) to increase transparency and accountability, contributing to improved humanitarian coordination; and (4) to facilitate a comprehensive review of services provided to those affected by the crisis.

  5. Emergency Kausch-Whipple procedure: indications and experiences.

    Science.gov (United States)

    Standop, Jens; Glowka, Tim; Schmitz, Volker; Schaefer, Nico; Hirner, Andreas; Kalff, Jörg C

    2010-03-01

    Pancreaticoduodenectomy is a demanding procedure even in selected patients but becomes formidable when performed in cases of emergency. This study analyzed our experience with urgent pancreatoduodenectomies; special emphases were put on the evaluation of diagnostic means and the validation of existing indications for performance of this procedure. Three hundred one patients who underwent pancreatoduodenectomy between 1989 and 2008 were identified from a pancreatic resection database and reviewed for emergency indications. Six patients (2%) underwent emergency pancreatoduodenectomy. Indications included endoscopy-related perforation, postoperative complications, and uncontrollable intraduodenal tumor bleeding. Length of stay and occurrence of nonsurgical complications were increased in emergency compared with elective pancreatoduodenectomies. Although increased, no significant differences were found regarding mortality and surgery-related complications. Indications for emergency pancreatoduodenectomies were based on clinical decisions rather than on radiologic diagnostics. Urgent pancreatic head resections may be considered as an option in selected patients if handling of local complications by interventional measures or limited surgery seems unsafe.

  6. More patients should undergo surgery after sigmoid volvulus.

    Science.gov (United States)

    Ifversen, Anne Kathrine Wewer; Kjaer, Daniel Willy

    2014-12-28

    To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus. We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery. Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality. Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or PEC insertion if feasible.

  7. [Financial analysis of a department of general surgery in a French hospital. The new "fee-for-service" reimbursement system results in a high deficit for emergency care].

    Science.gov (United States)

    Burdy, G; Dalban-Sillas, B; Leclerc, C; Bonnaventure, F; Roullet Audy, J-C; Frileux, P

    2009-10-01

    The aim of this study was to perform a detailed analysis of income and expense in a department of general surgery in a French hospital under the new system of funding based on a "fee-for-service" principle. All hospital stays of year 2006 were analysed retrospectively. The conditions of admission (elective vs. emergency), the principal diagnosis, and surgical procedures were examined. We determined hospital costs and the reimbursement for every admission. One thousand nine hundred and eighty-five hospitalizations generated an income of 8Meuros with a deficit of 1.3Meuros. The 775 elective admissions generated 50% of the income and 13% of the deficit (178,562euros). Seven hundred and forty-nine emergency admissions generated 45% of the income and 82% of deficit (1.1Meuros). Four hundred and sixty-one admissions for endoscopy generated 5% of the income and 5% of the deficit (67,249euros). Hospital stays of less than two days (the minimum duration of stay for total reimbursement) caused a loss of 122,624euros. Length of hospital stay below the lower limit caused a loss of 42,850euros. Elective surgical activity in digestive surgery can generate a balanced budget provided the length of hospital stay is reduced to the minimum, sometimes to the detriment of patient comfort. Emergency admissions result in a large deficit between cost and reimbursement; this fact may lead hospitals to avoid emergency activity in the future unless appropriate remedial measures are taken.

  8. MO-DE-202-00: Image-Guided Interventions: Advances in Intraoperative Imaging, Guidance, and An Emerging Role for Medical Physics in Surgery

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

  9. Screening Models for Cardiac Risk Evaluation in Emergency Abdominal Surgery. I. Evaluation of the Intraoperative Period Risk based on Data from the Preoperative Period

    Directory of Open Access Journals (Sweden)

    Mikhail Matveev

    2008-04-01

    Full Text Available A classification of intraoperative cardio-vascular complications (CVC was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA for CVC in noncardiac surgery. There were 370 intraoperative CVC registered, distributed as follows: groups with low risk (148, moderate risk (200, and high risk (22. Patient groups were formed, according to the CVC risk level, during the intraoperative period, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardiovascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. On the basis of these indices, a new distribution of the risk factors was implemented, into groups with different levels of risk of CVC during intraoperative period. This result is a solid argument, substantiating the proposal to introduce these adjustments for determining the severity of CVC in the specific conditions of emergency abdominal surgery.

  10. Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2016-06-15

    By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change.

  11. Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee

    2016-01-01

    By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change

  12. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

    Science.gov (United States)

    Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

    2010-07-01

    We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

  13. Current management of surgical oncologic emergencies.

    Science.gov (United States)

    Bosscher, Marianne R F; van Leeuwen, Barbara L; Hoekstra, Harald J

    2015-01-01

    For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  14. Colonic stenting as a bridge to surgery for obstructive colorectal cancer: advantages and disadvantages.

    Science.gov (United States)

    Haraguchi, Naotsugu; Ikeda, Masataka; Miyake, Masakazu; Yamada, Takuya; Sakakibara, Yuko; Mita, Eiji; Doki, Yuichiro; Mori, Masaki; Sekimoto, Mitsugu

    2016-11-01

    To clarify the advantages and disadvantages of stenting as a bridge to surgery (BTS) by comparing the clinical features and outcomes of patients who underwent BTS with those of patients who underwent emergency surgery (ES). We assessed technical success, clinical success, surgical procedures, stoma formation, complications, clinicopathological features, and Onodera's prognostic nutritional index (OPNI) in patients who underwent BTS and those who underwent ES. Twenty-six patients underwent stenting, which was successful in 22 (BTS group). The remaining four patients with unsuccessful stenting underwent emergency surgery. A total of 22 patients underwent emergency surgery (ES group). The rates of technical and clinical success were 85.0 and 81.0 %, respectively. The proportion of patients able to be treated by laparoscopic surgery (P = 0.0001) and avoid colostomy (P = 0.0042) was significantly higher in the BTS group. Although the incidence of anastomotic leakage in the two groups was not significantly different, it was significantly reduced by colonoscopic evaluation of obstructive colitis (P = 0.0251). The mean number of harvested lymph nodes (P = 0.0056) and the proportion of D3 lymphadenectomy (P = 0.0241) were significantly greater in the BTS group. Perineural invasion (PNI) was noted in 59.1 and 18.2 % of the BTS group and ES group patients, respectively (P = 0.0053). OPNI and serum albumin decreased significantly after stenting (P = 0.0084). The advantages of stenting as a BTS were that it avoided colostomy and allowed for laparoscopic surgery and lymphadenectomy, whereas its disadvantage lay in the decreased PNI and OPNI levels. A larger study including an analysis of prognosis is warranted.

  15. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

    Directory of Open Access Journals (Sweden)

    Patel Pranav H

    2012-03-01

    Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  16. Refractive corneal surgery - discharge

    Science.gov (United States)

    ... surgery. Avoid contact sports (such as boxing and football) for the first 4 weeks after surgery. DO ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

  17. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-10-01

    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine prognostic factors for death and survival with or without complications in cardiac arrest patients who received cardiopulmonary resuscitation (CPR within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: A retrospective cohort study approved by the Maharaj Nakorn Chiang Mai University Hospital Ethical Committee. Data used were taken from records of 751 cardiac arrest patients who received their first CPR within 24 hours of anesthesia for emergency surgery between January 1, 2003 and October 31, 2011. The reviewed data included patient characteristics, surgical procedures, American Society of Anesthesiologist (ASA physical status classification, anesthesia information, the timing of cardiac arrest, CPR details, and outcomes at 24 hours after CPR. Univariate and polytomous logistic regression analyses were used to determine prognostic factors associated with the outcome variable. P-values of less than 0.05 were considered statistically significant. Results: The outcomes at 24 hours were death (638/751, 85.0%, survival with complications (73/751, 9.7%, and survival without complications (40/751, 5.3%. The prognostic factors associated with death were: age between 13–34 years (OR =3.08, 95% CI =1.03–9.19; ASA physical status three and higher (OR =6.60, 95% CI =2.17–20.13; precardiopulmonary comorbidity (OR =3.28, 95% CI =1.09–9.90; the condition of patients who were on mechanical ventilation prior to receiving anesthesia (OR =4.11, 95% CI =1.17–14.38; surgery in the upper abdominal site (OR =14.64, 95% CI =2.83–75.82; shock prior to cardiac arrest (OR =6.24, 95% CI =2.53–15

  18. Identifying Opportunities for Virtual Reality Simulation in Surgical Education: A Review of the Proceedings from the Innovation, Design, and Emerging Alliances in Surgery (IDEAS) Conference: VR Surgery

    Science.gov (United States)

    Olasky, Jaisa; Sankaranarayanan, Ganesh; Seymour, Neal E.; Magee, J. Harvey; Enquobahrie, Andinet; Lin, Ming C.; Aggarwal, Rajesh; Brunt, L. Michael; Schwaitzberg, Steven D.; Cao, Caroline G. L.; De, Suvranu; Jones, Daniel B.

    2015-01-01

    Objectives To conduct a review of the state of virtual reality (VR) simulation technology, to identify areas of surgical education that have the greatest potential to benefit from it, and to identify challenges to implementation. Background Data Simulation is an increasingly important part of surgical training. VR is a developing platform for using simulation to teach technical skills, behavioral skills, and entire procedures to trainees and practicing surgeons worldwide. Questions exist regarding the science behind the technology and most effective usage of VR simulation. A symposium was held to address these issues. Methods Engineers, educators, and surgeons held a conference in November 2013 both to review the background science behind simulation technology and to create guidelines for its use in teaching and credentialing trainees and surgeons in practice. Results Several technologic challenges were identified that must be overcome in order for VR simulation to be useful in surgery. Specific areas of student, resident, and practicing surgeon training and testing that would likely benefit from VR were identified: technical skills, team training and decision-making skills, and patient safety, such as in use of electrosurgical equipment. Conclusions VR simulation has the potential to become an essential piece of surgical education curriculum but depends heavily on the establishment of an agreed upon set of goals. Researchers and clinicians must collaborate to allocate funding toward projects that help achieve these goals. The recommendations outlined here should guide further study and implementation of VR simulation. PMID:25925424

  19. Identifying Opportunities for Virtual Reality Simulation in Surgical Education: A Review of the Proceedings from the Innovation, Design, and Emerging Alliances in Surgery (IDEAS) Conference: VR Surgery.

    Science.gov (United States)

    Olasky, Jaisa; Sankaranarayanan, Ganesh; Seymour, Neal E; Magee, J Harvey; Enquobahrie, Andinet; Lin, Ming C; Aggarwal, Rajesh; Brunt, L Michael; Schwaitzberg, Steven D; Cao, Caroline G L; De, Suvranu; Jones, Daniel B

    2015-10-01

    To conduct a review of the state of virtual reality (VR) simulation technology, to identify areas of surgical education that have the greatest potential to benefit from it, and to identify challenges to implementation. Simulation is an increasingly important part of surgical training. VR is a developing platform for using simulation to teach technical skills, behavioral skills, and entire procedures to trainees and practicing surgeons worldwide. Questions exist regarding the science behind the technology and most effective usage of VR simulation. A symposium was held to address these issues. Engineers, educators, and surgeons held a conference in November 2013 both to review the background science behind simulation technology and to create guidelines for its use in teaching and credentialing trainees and surgeons in practice. Several technologic challenges were identified that must be overcome in order for VR simulation to be useful in surgery. Specific areas of student, resident, and practicing surgeon training and testing that would likely benefit from VR were identified: technical skills, team training and decision-making skills, and patient safety, such as in use of electrosurgical equipment. VR simulation has the potential to become an essential piece of surgical education curriculum but depends heavily on the establishment of an agreed upon set of goals. Researchers and clinicians must collaborate to allocate funding toward projects that help achieve these goals. The recommendations outlined here should guide further study and implementation of VR simulation. © The Author(s) 2015.

  20. Incidence of Bradycardia and Outcomes of Patients Who Underwent Orbital Atherectomy Without a Temporary Pacemaker.

    Science.gov (United States)

    Lee, Michael S; Nguyen, Heajung; Shlofmitz, Richard

    2017-02-01

    We analyzed the incidence of bradycardia and the safety of patients with severely calcified coronary lesions who underwent orbital atherectomy without the insertion of a temporary pacemaker. The presence of severely calcified coronary lesions can increase the complexity of percutaneous coronary intervention due to the difficulty in advancing and optimally expanding the stent. High-pressure inflations to predilate calcified lesions may cause angiographic complications like perforation and dissection. Suboptimal stent expansion is associated with stent thrombosis and restenosis. Orbital atherectomy safely and effectively modifies calcified plaque to facilitate optimal stent expansion. The incidence of bradycardia in orbital atherectomy is unknown. Fifty consecutive patients underwent orbital atherectomy from February 2014 to September 2016 at our institution, none of whom underwent insertion of a temporary pacemaker. The final analysis included 47 patients in this retrospective study as 3 patients were excluded because of permanent pacemaker implantation. The primary endpoint was significant bradycardia, defined as bradycardia requiring emergent pacemaker placement or a heart rate pacemaker appears to be safe.

  1. A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery.

    Science.gov (United States)

    Dy, Christopher J; Baty, Jack; Saeed, Mohammed J; Olsen, Margaret A; Osei, Daniel A

    2016-09-01

    Despite the importance of timely evaluation for patients with brachial plexus injuries (BPIs), in clinical practice we have noted delays in referral. Because the published BPI experience is largely from individual centers, we used a population-based approach to evaluate the delivery of care for patients with BPI. We used statewide administrative databases from Florida (2007-2013), New York (2008-2012), and North Carolina (2009-2010) to create a cohort of patients who underwent surgery for BPI (exploration, repair, neurolysis, grafting, or nerve transfer). Emergency department and inpatient records were used to determine the time interval between the injury and surgical treatment. Distances between treating hospitals and between the patient's home ZIP code and the surgical hospital were recorded. A multivariable logistic regression model was used to determine predictors for time from injury to surgery exceeding 365 days. Within the 222 patients in our cohort, median time from injury to surgery was 7.6 months and exceeded 365 days in 29% (64 of 222 patients) of cases. Treatment at a smaller hospital for the initial injury was significantly associated with surgery beyond 365 days after injury. Patient insurance type, travel distance for surgery, distance between the 2 treating hospitals, and changing hospitals between injury and surgery did not significantly influence time to surgery. Nearly one third of patients in Florida, New York, and North Carolina underwent BPI surgery more than 1 year after the injury. Patients initially treated at smaller hospitals are at risk for undergoing delayed BPI surgery. These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  2. Role of surgery in the management of otogenic meningitis.

    Science.gov (United States)

    Slovik, Y; Kraus, M; Leiberman, A; Kaplan, D M

    2007-09-01

    Meningitis is a life-threatening complication of otitis media. The appropriate management and the role of surgical intervention are still controversial, and there are no evidence-based guidelines in this regard. We report three cases of otogenic meningitis, initially treated with parenteral antibiotics and myringotomy, followed by surgery. Two patients had an emergency mastoidectomy and one patient underwent surgery one month post-recovery due to the suspicion of bone erosion on a computed tomography scan. In two cases, a canal wall up procedure was performed, and one patient underwent revision of a radical mastoidectomy. In all cases, no pus or granulations were seen in the mastoid. Two patients fully recovered and one patient died. We review the literature and critically discuss the role, timing and preferred type of surgery for otogenic meningitis.

  3. Effects of a surgical ward care protocol following open colon surgery as part of an enhanced recovery after surgery programme.

    Science.gov (United States)

    Kim, BoYeoul; Park, SungHee; Park, KyuJoo; Ryoo, SeungBum

    2017-11-01

    To investigate the effects of a standardised care protocol as part of an enhanced recovery after surgery programme on the management of patients who underwent open colon surgery at the University Hospital, South Korea. Patients who undergo open colon surgery often have concerns about their care as they prepare for hospitalisation. By shortening hospital stay lengths, enhanced recovery after surgery programmes could reduce the number of opportunities for patient education and communication with nurses. Therefore, our surgical team developed an enhanced recovery after surgery programme, applied using a care protocol for patients with colorectal cancer, that spans the entire recovery process. A retrospective, comparative study was conducted using a care protocol as part of an enhanced recovery after surgery programme. Comparisons were made before and after the implementation of an enhanced recovery after surgery programme with a care protocol. Records of 219 patients who underwent open colon surgery were retrospectively audited. The records were grouped according to the care protocol used (enhanced recovery after surgery programme with a care protocol or traditional care programme). The outcomes, including postoperative bowel function recovery, postoperative pain control, recovery time and postoperative complications, were compared between two categories. Patients who were managed using the programme with a care protocol had shorter hospital stays, fewer complications, such as postoperative ileus wound infections, and emergency room visits than those who were managed using the traditional care programme. The findings can be used to facilitate the implementation of an enhanced recovery after surgery programme with a care protocol following open colon surgery. We present a care protocol that enables effective management using consistent and standardised education providing bedside care for patients who undergo open colon surgery. This care protocol empowers long

  4. [Robots in general surgery: present and future].

    Science.gov (United States)

    Galvani, Carlos; Horgan, Santiago

    2005-09-01

    Robotic surgery is an emerging technology. We began to use this technique in 2000, after it was approved by the Food and Drug Administration. Our preliminary experience was satisfactory. We report 4 years' experience of using this technique in our institution. Between August 2000 and December 2004, 399 patients underwent robotic surgery using the Da Vinci system. We performed 110 gastric bypass procedures, 30 Lap band, 59 Heller myotomies, 12 Nissen fundoplications, 6 epiphrenic diverticula, 18 total esophagectomies, 3 esophageal leiomyoma resections, 1 pyloroplasty, 2 gastrojejunostomies, 2 transduodenal sphincteroplasties, 10 adrenalectomies and 145 living-related donor nephrectomies. Operating times for fundoplications and Lap band were longer. After the learning curve, the operating times and morbidity of the remaining procedures were considerably reduced. Robot-assisted surgery allows advanced laparoscopic procedures to be performed with enhanced results given that it reduces the learning curve as measured by operating time and morbidity.

  5. Effect-site concentration of remifentanil for preventing cough during emergence in elderly patients undergoing nasal surgery: a comparison with adult patients

    Directory of Open Access Journals (Sweden)

    Yoo JY

    2016-09-01

    Full Text Available Ji Young Yoo,1 Jong Yeop Kim,1 Hyun Jeong Kwak,2 Dong Chul Lee,2 Go Wun Kim,1 Sook Young Lee,1 Yun Jeong Chae1 1Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, 2Department of Anaesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, Korea Purpose: Prevention of cough during emergence after nasal surgery is important for avoiding surgical site bleeding. We investigated the remifentanil effect-site concentration in 50% (EC50 of the elderly patients undergoing nasal surgery for smooth emergence without cough and compared it with that of adult patients.Methods: Twenty-two elderly (aged 65–80 years and 25 adult patients (aged 20–60 years with an American Society of Anesthesiologists physical status I/II undergoing nasal surgery were enrolled. Anesthesia was maintained with sevoflurane and remifentanil. Remifentanil EC50 and EC95 for preventing cough were determined using the modified Dixon’s up-and-down method and isotonic regression with bootstrapping approach. Recovery profiles were also recorded.Results: With Dixon’s up-and-down method, the EC50 of remifentanil in elderly patients (2.40±0.25 ng/mL was not significantly different from that of adults (2.33±0.30 ng/mL (P=0.687. With isotonic regression, the EC95 of remifentanil in elderly patients (3.32 [95% confidence interval: 3.06–3.38] ng/mL was not significantly different from that of adults (3.30 [95% confidence interval: 2.96–3.37] ng/mL. However, eye opening time (14.1±3.8 vs 12.0±2.9 seconds, extubation time (17.2±4.1 vs 14.0±3.0 seconds, and postanesthesia care unit duration (44.5±7.6 vs 38.7±3.4 minutes in elderly patients were significantly longer than those in adults (P<0.05.Conclusion: Remifentanil EC50 for preventing cough after nasal surgery with sevoflurane anesthesia did not differ between elderly and adult patients. However, delayed awakening and respiratory adverse events may warrant attention

  6. Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery

    OpenAIRE

    Blankush, Joseph M.; Leitman, I. Michael; Soleiman, Aron; Tran, Trung

    2016-01-01

    Background: A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infections. Such infections increase morbidity, length of stay, and overall cost. This study evaluates the correlation between elevated pre-operative glycosylated hemoglobin (HbA1c) and post-operative infections. Study design: Adult patients undergoing non-emergent procedures across all surgical subspecialties from January...

  7. CLINICAL EVALUATION OF PREOPERATIVE SKIN PREPARATION WITH AQUEOUS POVIDONE IODINE ONLY AND IN COMBINATION WITH ALCHOLIC CHLORHEXIDINE IN PATIENTS UNDERGOING ELECTIVE AND EMERGENCY SURGERIES

    Directory of Open Access Journals (Sweden)

    Latchu

    2015-10-01

    Full Text Available INTRODUCTION: Many techniques are there for skin preparation before surgery, the commonest being initial scrub with antiseptic soap solution, followed by painting the prepared area with antiseptic paint solution. But degerming of the skin can be done with antiseptics us ed for less than one minute which is as effective as five minute scrub with germicidal soap solution followed by painting with antiseptics . AIMS AND OBJECTIVES : 1. To evaluate the efficacy of povidone iodine alone and antiseptic agent containing alcoholic chlorhexidine with povidone iodine in preoperative skin preparation by taking swab culture. 2. To compare the rate of postoperative wound infection in both the groups . METHODS: STUDY DESIGN: Comparative study conducted on 100 patients in two groups. STUDY SETTING: Sri Venkateswara Medical College Tirupathi SOURCE OF DATA: 100 Patients (50 in each Group undergoing elective and emergency surgery admitted in the Department of General Surgery in S.V.R.R. Government General Hospital, Tirupati from 2013 to 2014. INCLUSION CRITERIA: 1. Patients undergoing elective & emergency surgery in department of general surgery. 2. Patients with no focus of infection anywhere on the body. 3. Patients irrespective of their age and sex. 4. Patients neither immunocompromised nor on any long term steroids. 5. Patients undergoing mes h repair of hernia are also included. EXCLUSION CRITERIA: 1. Immuno compromised patients and patients on long term steroids. 2. Patients with septicemia. 3. Patients suffering from malignancies or undergoing chemotherapy or radiation therapy. 4. Contaminat ed surgeries in which viscus was opened were excluded from the study. 5. Patients with co - morbid medical conditions like diabetes, hypertension etc. METHOD OF COLLECTION OF DATA: In each case preoperatively, detailed history was taken and routine investiga tions like haemoglobin, total count, differential count, ESR, RBS and chest X - ray, ultrasound were done to

  8. Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Nakamura, Yoshiharu; Matsushita, Akira; Katsuno, Akira; Yamahatsu, Kazuya; Sumiyoshi, Hiroki; Mizuguchi, Yoshiaki; Uchida, Eiji

    2016-02-01

    The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  9. Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park.

    Science.gov (United States)

    Sesma, Julio; Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

    2017-08-01

    Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3 rd postoperative day and patient was discharged on 14 th postoperative day. He has already recovered his normal activity 6 months after surgery.

  10. Relationship between admission blood glucose level and prognosis in elderly patients without previously known diabetes who undergo emergency non-cardiac surgery.

    Science.gov (United States)

    Ma, Jinling; He, Lei; Wang, Xiujie; Gao, Meng; Zhao, Yuexiang; Liu, Jie

    2015-08-01

    Elevated blood glucose levels on admission are important as a marker for adverse events in patients who undergo surgery. This study aims to evaluate the relationship between admission glucose level and adverse outcome during the 30-day follow-up period in elderly patients without previously known diabetes who undergo emergency non-cardiac surgery. The primary and secondary end points were all-cause and major adverse cardiac event (MACE) mortalities, respectively, during the 30-day postoperative follow-up period. Higher 30-day all-cause (24.1 %) and MACE (13.7 %) mortalities were observed in patients with an admission glucose ≥ 11.1 mmol/L than in patients with admission glucose blood glucose level is an independent predictor for the development of the 30-day all-cause mortality [odds ratio (OR), 1.91; 95 % confidence interval (CI), 1.746-2.082; p blood glucose level ≥ 11.1 mmol/L has worse event-free survival than an admission blood glucose level <11.1 mmol/L.

  11. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution.

    Science.gov (United States)

    Cooper, Zara; Courtwright, Andrew; Karlage, Ami; Gawande, Atul; Block, Susan

    2014-12-01

    To provide a description of communication breakdowns and to identify interventions to improve surgical decision making for elderly patients with serious illness and acute, life-threatening surgical conditions. Communication between surgeons, patients, and surrogates about goals of treatment plays an important and understudied role in determining the surgical interventions elderly patients with serious illness receive. Communication breakdowns may lead to nonbeneficial procedures in acute events near the end of life. We review the available literature on factors that lead to communication challenges and nonbeneficial surgery at the end of life. We use this review to identify solutions for navigating surgical decision making for seriously ill elderly patients with acute surgical conditions. Surgeon, patient, surrogate, and systemic factors-including time constraints, inadequate provider communication skills and training, uncertainty about prognosis, patient and surrogate anxiety and fear of inaction, and limitations in advance care planning-contribute to communication challenges and nonbeneficial surgery at the end of life. Surgeons could accomplish more effective communication with seriously ill elderly patients if they had a structured, standardized approach to exploring patients' preferences and to integrating those preferences into surgical decisions in the acute setting. Improved communication among surgeons, patients, and surrogates is necessary to ensure that patients receive the care that they want and to avoid nonbeneficial treatment. Further research is needed to learn how to best structure these conversations in the emergency surgical setting.

  12. Emergency surgery and Limitation of therapeutic effort in relation to neurologic deterioration in elderly patients – a survey of European surgeons

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    Mihai Păduraru

    2017-10-01

    Full Text Available Background. In emergency surgery, a very heterogeneous approach is required in the decision making process, especially when considering the patient’s postoperative quality of life as well as medical, ethical, and legal factors. In some cases, the presence of an Advance Directive (AD form may potentially help resolve the surgeon’s dilemma. Objectives. The primary objective of this survey was to investigate the opinions of surgeons across a representative cross-section of European countries regarding the decision making process using a specific case scenario so as to identify similarities and differences in practice. A secondary objective was to identify the possibility of establishing a more uniform approach and best practice. Method. A survey was conducted of surgeons from a range of European countries. Questionnaires were designed to obtain an overview of decision making in relation to the Limitation of Therapeutic Effort (LTE using a specific case study and the level of awareness and practical use of ADs. Surveys were distributed via email to the members of the ESTES (European Society for Trauma and Emergency Surgery and AEC (Association of Spanish surgeons, with voluntary, anonymous participation. Conclusions. Clear and additional support in the form of legal and ethical guidance with clinical protocols for surgical practice in such case scenarios is necessary. Wider use of ADs, together with education about their role and support for patients and relatives, would benefit the type of patient described in our scenario. A multidisciplinary team should play a more active role in decision making in order to avoid surgical procedures that are potentially futile. The concepts of LTE and Quality of life need a broader understanding among surgeons as well as more consistent application.

  13. Cirurgia cardíaca de emergência para ressecção de mixoma atrial esquerdo Cardiac surgery of emergency for resection of left atrial myxoma

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    Antônio Augusto Ramalho Motta

    2008-06-01

    Full Text Available É descrito caso de paciente do sexo feminino que apresentava manifestações pulmonares e sistêmicas inespecíficas há vários meses, as quais resultaram em várias internações hospitalares com a hipótese diagnóstica de fibrose pulmonar. Estudo ecocardiográfico evidenciou a presença de grande mixoma pediculado no átrio esquerdo, que prolapsava, através da valva mitral, para o ventrículo esquerdo. Em condições clínicas bastante desfavoráveis, a paciente foi encaminhada ao nosso Serviço para tratamento cirúrgico, evoluindo durante o preparo pré-operatório com edema agudo pulmonar e instabilidade hemodinâmica, sendo submetida a cirurgia de emergência, com sucesso, para ressecção da tumoração. A paciente encontra-se assintomática.We report case of a female patient who during months presented pulmonary manifestation associated with nonspecific systemic symptoms resulting in several hospitalizations with the diagnostic hypothesis of pulmonary fibrosis. The echocardiographic study showed a great pedunculated left atrial myxoma prolapsing through the mitral valve for the left ventricle. In quite unfavorable clinical conditions the patient was sent to our Service for surgical treatment, evolving during the preparation for surgery with acute pulmonary edema and hemodinamic instability being submitted to a successfully surgery of emergency for resection of the tumor. The patient is asymptomatic.

  14. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

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    Marcos George de Souza Leão

    Full Text Available ABSTRACT OBJECTIVES: To evaluate through the visual analog scale (VAS the pain in patients undergoing total knee replacement (TKR with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard and the other with systolic blood pressure plus 100 mmHg (P + 100. These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM, complications, and blood drainage volume in each group; the data were subjected to statistical analysis. RESULTS: After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612, ROM (p = 0.202, bleeding after 24 and 48 h (p = 0.432 and p = 0.254 or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding. CONCLUSIONS: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

  15. Serum Glutamine Levels as a Potential Diagnostic Biomarker in Sepsis following Surgery for Peritonitis.

    Science.gov (United States)

    Yang, Chun-Ju; Huang, Ting-Shuo; Lee, Tung-Liang; Yang, Kang-Chung; Yuan, Shin-Sheng; Lu, Ruey-Hwa; Hsieh, Chung-Ho; Shyu, Yu-Chiau

    2017-12-31

    Few diagnostic biomarkers for sepsis after emergency peritonitis surgery are available to clinicians, and, thus, it is important to develop new biomarkers for patients undergoing this procedure. We investigated whether serum glutamine and selenium levels could be diagnostic biomarkers of sepsis in individuals recovering from emergency peritonitis surgery. From February 2012 to March 2013, patients who had peritonitis diagnosed at the emergency department and underwent emergency surgery were screened for eligibility. Serum glutamine and selenium levels were obtained at pre-operative, post-operative and recovery time points. The average level of pre-operation serum glutamine was significantly different from that on the recovery day (0.317 ± 0.168 vs. 0.532 ± 0.155 mM, P peritonitis. We recommend including glutamine as a biomarker for sepsis severity assessment in addition to the commonly used clinical indicators.

  16. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society

    Science.gov (United States)

    2010-01-01

    Background Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC. Methods The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced. Results Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B). Conclusions Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic

  17. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES and peritoneum and surgery (PnS society

    Directory of Open Access Journals (Sweden)

    Pinna Antonio D

    2010-12-01

    Full Text Available Abstract Background Obstructive left colon carcinoma (OLCC is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC. Methods The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES and Peritoneum and Surgery (PnS Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced. Results Hartmann's procedure should be preferred to loop colostomy (Grade 2B. Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+; Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C. Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A. Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A. In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B. Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B. Conclusions Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of

  18. Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery)

    Science.gov (United States)

    2014-01-01

    Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients

  19. Current management of surgical oncologic emergencies.

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    Marianne R F Bosscher

    Full Text Available For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC. In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  20. Prediction of Pathological Complete Response Using Endoscopic Findings and Outcomes of Patients Who Underwent Watchful Waiting After Chemoradiotherapy for Rectal Cancer.

    Science.gov (United States)

    Kawai, Kazushige; Ishihara, Soichiro; Nozawa, Hiroaki; Hata, Keisuke; Kiyomatsu, Tomomichi; Morikawa, Teppei; Fukayama, Masashi; Watanabe, Toshiaki

    2017-04-01

    Nonoperative management for patients with rectal cancer who have achieved a clinical complete response after chemoradiotherapy is becoming increasingly important in recent years. However, the definition of and modality used for patients with clinical complete response differ greatly between institutions, and the role of endoscopic assessment as a nonoperative approach has not been fully investigated. This study aimed to investigate the ability of endoscopic assessments to predict pathological regression of rectal cancer after chemoradiotherapy and the applicability of these assessments for the watchful waiting approach. This was a retrospective comparative study. This study was conducted at a single referral hospital. A total of 198 patients with rectal cancer underwent preoperative endoscopic assessments after chemoradiotherapy. Of them, 186 patients underwent radical surgery with lymph node dissection. The histopathological findings of resected tissues were compared with the preoperative endoscopic findings. Twelve patients refused radical surgery and chose watchful waiting; their outcomes were compared with the outcomes of patients who underwent radical surgery. The endoscopic criteria correlated well with tumor regression grading. The sensitivity and specificity for a pathological complete response were 65.0% to 87.1% and 39.1% to 78.3%. However, endoscopic assessment could not fully discriminate pathological complete responses, and the outcomes of patients who underwent watchful waiting were considerably poorer than the patients who underwent radical surgery. Eventually, 41.7% of the patients who underwent watchful waiting experienced uncontrollable local failure, and many of these occurrences were observed more than 3 years after chemoradiotherapy. The number of the patients treated with the watchful waiting strategy was limited, and the selection was not randomized. Although endoscopic assessment after chemoradiotherapy correlated with pathological response

  1. Case report: Anesthesia management for emergency cesarean section in a patient with dwarfism.

    Science.gov (United States)

    Li, Xiaoxi; Duan, Hongjun; Zuo, Mingzhang

    2015-04-28

    Dwarfism is characterized by short stature. Pregnancy in women with dwarfism is uncommon and cesarean section is generally indicated for delivery. Patients with dwarfism are high-risk population for both general and regional anesthesia, let alone in an emergency surgery. In this case report we present a 27-year-old Chinese puerpera with dwarfism who underwent emergency cesarean section under combined spinal and epidural anesthesia. It is an original case report, which provides instructive significance for anesthesia management especially combined spinal and epidural anesthesia in this rare condition. There was only one former article that reported a puerpera who underwent combined spinal and epidural anesthesia for a selective cesarean section.

  2. Benchmarking against the National Emergency Laparotomy Audit recommendations.

    Science.gov (United States)

    Ho, Yiu Ming; Cappello, Julie; Kousary, Ramin; McGowan, Brian; Wysocki, Arkadiusz P

    2018-05-01

    The Royal College of Anaesthetists published the National Emergency Laparotomy Audit (NELA) to describe and compare inpatient care and outcomes of major emergency abdominal surgery in England and Wales in 2015 and 2016. The purpose of this article is to compare emergency abdominal surgical care and mortality in a regional hospital (Logan Hospital, Queensland, Australia) with NELA results. Data were extracted from two databases. All deaths from May 2010 to April 2015 were reviewed and patients who had an emergency abdominal operation within 30 days of death were identified. The health records of all patients who underwent abdominal surgery were extracted and those who had an emergency laparotomy were identified for analysis. Three hundred and fifty patients underwent emergency laparotomy and were included in the analysis. The total 30-day mortality during this 5-year period was 9.7%. Factors affecting mortality included age, Portsmouth-Physiological and Operative Severity Score (P-POSSUM) and admission source. Timing of antibiotic administration, use of perioperative medical service and frequency of intensive care admission were the same in patients who died and survived. Mortality in patients following emergency laparotomy at Logan Hospital compares favourably with 11.1% reported by NELA. This may be partly attributable to case mix distribution as for each P-POSSUM risk Logan Hospital mortality was at the upper end of that reported by NELA. Further Australia data are required. Improved compliance with NELA recommendations may improve outcomes. © 2017 Royal Australasian College of Surgeons.

  3. Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial.

    Science.gov (United States)

    Lee, Li-Ang; Chao, Yi-Ping; Huang, Chung-Guei; Fang, Ji-Tseng; Wang, Shu-Ling; Chuang, Cheng-Keng; Kang, Chung-Jan; Hsin, Li-Jen; Lin, Wan-Ni; Fang, Tuan-Jen; Li, Hsueh-Yu

    2018-02-13

    Electronic learning (e-learning) through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes and satisfaction in millennial medical students is unknown. The aim of this study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, and satisfaction for emergent ORL-HNS disorders. This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the group embedded figures test. The students were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional Microsoft PowerPoint show (PPS) group matched by age, sex, and cognitive style. The content for the gamified IM module was derived from and corresponded to the textbook-based learning material of the PPS module (video lectures). The participants were unblinded and used fully automated courseware containing the IM or PPS module on a 7-inch tablet for 100 min. Knowledge and competence were assessed using multiple-choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction. All of the participants (median age 23 years, range 22-26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, interquartile range [IQR]=17%-80%, Plearning modules (IM or PPS) had significant effects on both knowledge gain (both adjusted Plearning is an effective modality to improve knowledge of emergent ORL-HNS in millennial undergraduate medical students. Our findings suggest the necessity of developing various modules for undergraduate medical students with

  4. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability

    OpenAIRE

    Zhang, Lirong; Xu, Xiaohua; Jiang, Tiechao; Wu, Kunzhe; Ding, Chuanbo; Liu, Zhen; Zhang, Xuanhe; Yu, Tianhua; Song, Changlong

    2018-01-01

    Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS). Three main components (naringin, naringenin, and hesperetin) were isolated from C. aurantium. Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory f...

  5. Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program

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    Moises Cohen

    2004-12-01

    Full Text Available Introduction: Quality of life can be defined as the expression of aconceptual model that tries to represent patient’s perspectivesand his/her level of satisfaction expressed by numbers. Theobjective of this study is to evaluate the parameters of quality oflife of 23 patients who underwent surgery for anterior cruciateligament reconstruction. Methods: We adopted SF-36, a generichealth-related evaluation questionnaire, to obtain informationregarding several aspects of patients’ health conditions, and theLysholm questionnaire, specific to evaluate the symptoms andfunction of the knee. The questionnaires were applied at two stagesof the treatment: pre- and postoperatively (after the rehabilitationprogram. Results: Before surgery, the Lysholm questionnairepresented the following results: excellent in 4% of the cases, goodin 22%, fair in 22%, and poor in 52%. After surgery (Lysholm e SF-36 the correlation level was approximately 44% (p = 0.041.Discussion: The correlation between the Lysholm and the SF-36questionnaires showed the following: the lower the level of pain,the higher the Lysholm score. The high scores presented by theLysholm questionnaire are directly proportional to physical andemotional aspects, and to functional capacity. Conclusion:Analysis of both questionnaires, as well as of their correlation,showed some improvement in patients´ quality of life. We werealso able to demonstrate the importance and usefulness of applyingthe two questionnaires at three different moments: before, duringand after physiotherapeutic intervention.

  6. Serum Zn levels in dysphagic patients who underwent endoscopic gastrostomy for long term enteral nutrition

    OpenAIRE

    Adriana Santos, Carla; Fonseca, Jorge; Brito, José; Fernandes, Tânia; Gonçalves, Luísa; Sousa Guerreiro, António

    2014-01-01

    Background and aims: Dysphagic patients who underwent endoscopic gastrostomy (PEG) usually present protein-energy malnutrition, but little is known about micronutrient malnutrition. The aim of the present study was the evaluation of serum zinc in patients who underwent endoscopic gastrostomy and its relationship with serum proteins, whole blood zinc, and the nature of underlying disorder. Methods: From patients that underwent gastrostomy a blood sample was obtained minutes before the procedur...

  7. Measures of reducing obstetric emergencies hysterectomy incidence.

    Science.gov (United States)

    Ren, Guo-ping; Wang, Bao-lian; Wang, Yan-hong

    2016-03-01

    To study the obstetric emergency hysterectomy which can reduce the incidence of measures. In maternity of Xinxiang Central Hospital, the total number of deliveries cases has been up to 50,526 in 20 years, of which 48 cases were retrospectively analyzed for the clinical data of Emergency uterine surgery cases. Cases underwent obstetric emergency hysterectomy accounted for 0.095% of total deliveries (48/50 526), in which 11 cases of vaginal delivery, 37 cases of cesarean section. The indications for surgery: 27 cases were cased by placental factors accounted for 56.25%; 14 cases of uterine inertia, accounting for 29.17%; uterine rupture in 4 cases, accounting for 8.33%; 3 cases of coagulopathy, accounting for 6.25%. Where the maternal placental factors hysterectomy is the most common (69.70%, 23/33) and the predominant factor is early maternal uterine inertia (60.00%, 9/15). There are 74.09% (20/27) of patients with placental abnormalities history of previous cesarean section or uterine surgery. The major risk factors leading to obstetric emergency hysterectomy is placental factors. Preventing the occurrence of placental abnormalities planting actively can effectively reduce the rate of obstetric hysterectomy.

  8. Emergency cardiac surgery during transfemoral and transapical transcatheter aortic valve implantation: incidence, reasons, management, and outcome of 411 patients from a single center.

    Science.gov (United States)

    Griese, Daniel P; Reents, Wilko; Kerber, Sebastian; Diegeler, Anno; Babin-Ebell, Jörg

    2013-11-01

    Transcatheter aortic valve implantation (TAVI) is increasingly performed in high-risk patients with severe aortic valve stenosis. Incidence and impact of emergency cardiac surgery (ECS) during TAVI is unclear. Two-hundred twenty one transapical (TA) and 190 transfemoral (TF) TAVIs were performed at our hospital between 01/2009 and 12/2012. Twenty patients (4.9%) required ECS, more frequently in the TF- (n = 11; 5.8%) than in the TA-group (n = 9; 4.1%; P = 0.017). ECS-cases were evenly distributed throughout the 4 years. Baseline characteristics of the ECS-patients were not different from the non-ECS-patients. Reasons were acute cardiac failure, coronary obstruction, annular rupture, valve migration, right- and left-ventricular perforation, severe paravalvular leakage, aortic dissection, and mitral valve damage. Surgical intervention consisted of peripheral CPB, switch to TA, thoracotomy and suture of perforated cardiac chambers and conventional aortic valve replacement with concomitant repair of associated cardiovascular injury. Thirty-day mortality was 35.0%, and 55.0% could be salvaged to hospital discharge. Kaplan-Meier 1-year survival curves were significantly impaired for patients requiring ECS (TF: P proportion during TAVI. ECS dramatically affects early and late outcome after TAVI. Under optimal conditions more than half of the ECS-patients can be salvaged. With the current technology of THV-systems ECS should be an integral part of the logistic conditions surrounding TAVI and is far from being futile in this patient population. Copyright © 2013 Wiley Periodicals, Inc.

  9. An Analytical Comparison of the Opinions of Physicians Working in Emergency and Trauma Surgery Departments at Tabriz and Vienna Medical Universities Regarding Family Presence during Resuscitation.

    Science.gov (United States)

    Soleimanpour, Hassan; Behringer, Wilhelm; Tabrizi, Jafar Sadegh; Sarahrudi, Kambiz; Golzari, Samad E J; Hajdu, Stefan; Rasouli, Maryam; Nikakhtar, Mehdi; Mehdizadeh Esfanjani, Robab

    2015-01-01

    The present study evaluated the opinions of physicians working in the emergency and trauma surgery departments of Vienna Medical University, in Austria, and Tabriz Medical University, in Iran, regarding the presence of patients' relatives during resuscitation. In a descriptive-analytical study, the data obtained from questionnaires that had been distributed randomly to 40 specialists and residents at each of the participating universities were analyzed. The questionnaire consisted of two sections aimed at capturing the participants' demographic data, the participants' opinions regarding their support for the family's presence during resuscitation, and the multiple potential factors affecting the participants' attitudes, including health beliefs, triggers that could facilitate the procedure, self-efficacy, intellectual norms, and perceived behavioral control. The questionnaire also included a direct question (Question 16) on whether the participants approved of family presence. Each question could be answered using a Likert-type scale. The results showed that the mean scores for Question 16 were 4.31 ± 0.64 and 3.57 ± 1.31 for participants at Vienna and Tabriz universities, respectively. Moreover, physicians at Vienna University disapproved of the presence of patients' families during resuscitation to a higher extent than did those at Tabriz University (P = 0.018). Of the studied prognostic factors affecting the perspectives of Vienna Medical University's physicians, health beliefs (P = 0.000; B = 1.146), triggers (P = 0.000; B = 1.050), and norms (P = 0.000; B = 0.714) were found to be significant. Moreover, of the studied prognostic factors affecting the perspectives of Tabriz Medical University's physicians, health beliefs (P = 0.000; B = 0.875), triggers (P = 0.000; B = 1.11), self-efficacy (P = 0.001; B = 0.5), and perceived behavioral control (P = 0.03; B = 0.713) were significant. Most physicians at Vienna and Tabriz Medical universities were not open

  10. Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology-Head and Neck Surgery Disorders: Pilot Randomized Controlled Trial.

    Science.gov (United States)

    Lee, Li-Ang; Wang, Shu-Ling; Chao, Yi-Ping; Tsai, Ming-Shao; Hsin, Li-Jen; Kang, Chung-Jan; Fu, Chia-Hsiang; Chao, Wei-Chieh; Huang, Chung-Guei; Li, Hsueh-Yu; Chuang, Cheng-Keng

    2018-03-08

    The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module or a conventional PowerPoint show (PPS) module using M-TEL to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. The aim of this study was to compare the impact of a novel IM module with a conventional PPS module using M-TEL for emergent ORL-HNS disorders with regard to learning outcomes, satisfaction, and learning experience. This pilot study was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of the two groups matched by age, sex, and cognitive style: the IM group and the PPS group. During the 100-min learning period, the participants were unblinded to use the IM or PPS courseware on a 7-inch tablet. Pretests and posttests using multiple-choice questions to evaluate knowledge and multimedia situational tests to evaluate competence were administered. Participants evaluated their satisfaction and learning experience by the AttrakDiff2 questionnaire, and provided feedback about the modules. Overall, the participants had significant gains in knowledge (median of percentage change 71, 95% CI 1-100, Plearning. Although there was no significant difference in knowledge gain between the two groups (median of difference of percentage change 24, 95% CI -75 to 36; P=.55), competence gain was significantly lower in the IM group compared with the PPS group (median of difference of percentage change -41, 95% CI -67 to -20; P=.008). However, the IM group had significantly higher scores of satisfaction (difference 2, 95% CI 2-4; P=.01), pragmatic quality

  11. Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology–Head and Neck Surgery Disorders: Pilot Randomized Controlled Trial

    Science.gov (United States)

    Lee, Li-Ang; Wang, Shu-Ling; Chao, Yi-Ping; Tsai, Ming-Shao; Hsin, Li-Jen; Kang, Chung-Jan; Fu, Chia-Hsiang; Chao, Wei-Chieh; Huang, Chung-Guei; Li, Hsueh-Yu

    2018-01-01

    Background The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module or a conventional PowerPoint show (PPS) module using M-TEL to teach emergent otorhinolaryngology–head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. Objective The aim of this study was to compare the impact of a novel IM module with a conventional PPS module using M-TEL for emergent ORL-HNS disorders with regard to learning outcomes, satisfaction, and learning experience. Methods This pilot study was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of the two groups matched by age, sex, and cognitive style: the IM group and the PPS group. During the 100-min learning period, the participants were unblinded to use the IM or PPS courseware on a 7-inch tablet. Pretests and posttests using multiple-choice questions to evaluate knowledge and multimedia situational tests to evaluate competence were administered. Participants evaluated their satisfaction and learning experience by the AttrakDiff2 questionnaire, and provided feedback about the modules. Results Overall, the participants had significant gains in knowledge (median of percentage change 71, 95% CI 1-100, P<.001) and competence (median of percentage change 25, 95% CI 0-33, P=.007) after 100 min of learning. Although there was no significant difference in knowledge gain between the two groups (median of difference of percentage change 24, 95% CI −75 to 36; P=.55), competence gain was significantly lower in the IM group compared with the PPS group (median of difference of percentage change −41, 95% CI −67 to

  12. Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial

    Science.gov (United States)

    Chao, Yi-Ping; Huang, Chung-Guei; Fang, Ji-Tseng; Wang, Shu-Ling; Chuang, Cheng-Keng; Kang, Chung-Jan; Hsin, Li-Jen; Lin, Wan-Ni; Fang, Tuan-Jen; Li, Hsueh-Yu

    2018-01-01

    Background Electronic learning (e-learning) through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes and satisfaction in millennial medical students is unknown. Objective The aim of this study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, and satisfaction for emergent ORL-HNS disorders. Methods This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the group embedded figures test. The students were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional Microsoft PowerPoint show (PPS) group matched by age, sex, and cognitive style. The content for the gamified IM module was derived from and corresponded to the textbook-based learning material of the PPS module (video lectures). The participants were unblinded and used fully automated courseware containing the IM or PPS module on a 7-inch tablet for 100 min. Knowledge and competence were assessed using multiple-choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction. Results All of the participants (median age 23 years, range 22-26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, interquartile range [IQR]=17%-80%, P<.001) and competence (median 13%, IQR=0%-33%, P=.006). There were no significant differences in knowledge gain (40%, IQR=13%-76% vs 60%, IQR=20%-100%, P=.42) and competence gain (0%, IQR= −21% to 38% vs 25%, IQR=0%-33%, P=.16) between the IM and PPS groups. However, the IM group had

  13. Consequences of peritonism in an emergency department setting

    DEFF Research Database (Denmark)

    Bjørsum-Meyer, Thomas; Schmidt, Thomas A.

    2013-01-01

    Background: In patients who were referred to the emergency department (ED) with abdominal pain, it is crucial to determine the presence of peritonism to allow for appropriate handling and subsequent referral to stationary departments. We aimed to assess the incidence of perceived peritonism...... on the patients with abdominal pain. Following a physical examination, the patients with abdominal pain were divided into those who had clinical signs of peritonism and those who did not. Results: Among the 1,270 patients admitted to the ED, 10% had abdominal pain. In addition, 41% of these patients were found...... to have signs indicative of peritonism, and 90% were admitted to the Department of Surgery (DS). Also, 24% of those patients with signs of peritonism and admission to the DS underwent surgical intervention in terms of laparotomy/laparoscopy. Five of the patients without peritonism underwent surgery...

  14. [Analysis of projects received and funded in fields of emergency and intensive care medicine/trauma/burns/plastic surgery from National Natural Science Foundation of China during 2010-2013].

    Science.gov (United States)

    Xiong, Kun; Wang, Linlin; Chen, Xulin; Cao, Yongqian; Xiang, Chuan; Xue, Lixiang; Yan, Zhangcai

    2014-01-01

    To summarized the projects received and funded in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery from National Natural Science Foundation of China (NSFC) during 2010-2013, put forward the thinking and perspective of this future trend in these fields. The number of the funded project and total funding in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery from NSFC during 2010-2013 had been statistical analyzed, in the meantime, the overview situation of various branches in basic research and further preliminary analysis the research frontier and hot issues have been analyzed. (1) The number of funded project were 581 in H15 of NSFC during 2010-2013, total funding reached to 277.13 million RMB, including 117 projects in H1511 (emergency and intensive care medicine/trauma/burns/plastic surgery and other science issue), 96 projects in H1507 (wound healing and scar), 88 projects in H1502 (multi-organ failure), 71 projects in H1505 (burn), 61 projects in H1504 (trauma). (2) The top 10 working unit for project funding in the field of emergency and intensive care medicine/trauma/burns/plastic surgery present as Third Military Medical University (70), Shanghai Jiao tong University (69), Second Military Medical University (40), Chinese PLA General Hospital (36), Forth Military Medical University (35), Zhejiang University (22), Sun Yat-Sen University (18), Southern Medical University (14), China Medical University (11), Capital Medical University (11) respectively, the number of funded project positive correlated with funding. (3) The funded research field in H15 covered almost all important organs and system injury or repair research, our scientists reached a fairly high level in some research field, for example, sepsis, trauma, repair, et al. "Sepsis" was funded 112 projects in H15 for 4 years, the growth rate became rapid and stable comparing to shock, burns and cardiopulmonary resuscitation funded projects

  15. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

    Energy Technology Data Exchange (ETDEWEB)

    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  16. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study.

    Science.gov (United States)

    Kim, Jong Wan; Kim, Jeong Yeon; Kang, Byung Mo; Lee, Bong Hwa; Kim, Byung Chun; Park, Jun Ho

    2016-01-01

    The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer. We conducted a retrospective review of patients who underwent surgery for transverse colon cancer at six Hallym University-affiliated hospitals between January 2005 and June 2015. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery. Of 226 patients with transverse colon cancer, 103 underwent laparoscopic surgery and 123 underwent open surgery. There were no differences in the patient characteristics between the two groups. Regarding perioperative outcomes, the operation time was significantly longer in the laparoscopic group than in the open group (267.3 vs 172.7 minutes, Pstudy showed that laparoscopic surgery is associated with several perioperative benefits and similar oncologic outcomes to open surgery for the resection of transverse colon cancer. Therefore, laparoscopic surgery offers a safe alternative to open surgery in patients with transverse colon cancer.

  17. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  18. Bariatric Surgery

    Science.gov (United States)

    ... often. Each type of surgery has advantages and disadvantages. Bariatric Surgery Benefits Bariatric surgery can improve many ... Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

  19. Lung surgery

    Science.gov (United States)

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  20. Plastic Surgery

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  1. Ovarian cancer surgery

    DEFF Research Database (Denmark)

    Seibaek, Lene; Blaakaer, Jan; Petersen, Lone Kjeld

    2013-01-01

    PURPOSE: The study objective was to survey general health and coping in women undergoing ovarian cancer surgery, and subsequently to develop and test a supportive care intervention. METHODS/MATERIALS: Women who underwent surgery on the suspicion of ovarian cancer participated in a follow...... standard levels. Concerning mental health, levels were below standard during the entire period, but did improve with time, also in women in whom the potential cancer diagnosis was refuted. The preoperative differences between these groups leveled out postoperatively in terms of physical health. At the end...

  2. [Evaluation of the antithrombotic strategy in low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis].

    Science.gov (United States)

    Aceves-Velázquez, Eduardo; Vieyra-Herrera, Gerardo; Rodríguez-Chávez, Laura; Herrera-Alarcón, Valentín

    2017-07-16

    According to current guidelines, in patients without additional risk factors who have undergone aortic valve replacement with a bioprosthesis, anticoagulation in the first 3 months after surgery is still a matter of debate. According to current evidence, aspirin in low doses is a reasonable alternative to vitamin K antagonists (VKA). A comparison is made between the incidence of thrombotic and haemorrhagic complications in patients with low thrombotic risk who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico. The hypothesis: aspirin as monotherapy has a beneficial effect compared to VKA. The studied patients were the low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico from 2011 to 2015. The groups studied were: aspirin only, VKA only, and the combination of VKA plus aspirin. The patients were retrospectively followed-up for 12 months, and the thrombotic and haemorrhagic complications were documented. Of the 231 patients included in the study, only one patient in the VKA only group presented with a haemorrhagic complication. No thrombotic complications were observed. In the present study no thrombotic complications were observed in patients who did not receive anticoagulation in the first 3 months after an aortic valve replacement with a bioprosthesis after a follow up period of 12 months. This suggests that the use of aspirin only is safe during this period. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  3. Conversion of laparoscopic surgery for perforated peptic ulcer: a single-center study.

    Science.gov (United States)

    Zimmermann, Markus; Hoffmann, Martin; Laubert, Tilman; Jung, Carlo; Bruch, Hans-Peter; Schloericke, Erik

    2015-11-01

    A perforated peptic ulcer can be managed laparoscopically in selected patients. The purpose of this study was to evaluate whether conversion of emergency laparoscopy is inferior to primary median laparotomy in terms of postoperative morbidity and mortality. We analyzed patients who underwent laparoscopic or open surgery for a perforated peptic ulcer at the Department of Surgery, University of Schleswig-Holstein, Campus Luebeck between January, 1996 and December, 2010. Perforations were graded according to the Boey classification, a preoperative risk-scoring system. Conversion to laparotomy was necessary in 20 of the 45 patients who underwent laparoscopic surgery (CG); therefore, laparoscopic operations were completed in 25 patients (LG). The third patient cohort comprised 139 patients who underwent primary laparotomy (OG). Overall minor morbidity was significantly lower (p = 0.048) in the LG patients than in the OG patients, whereas no significant differences were found in major morbidity and mortality, particularly between the OG and CG. Patients' suitability for laparoscopic management should be decided on according to Boey's clinical scoring system. Our findings demonstrated that conversion from laparoscopy to laparotomy was not associated with elevated postoperative morbidity or mortality versus initial laparotomy. Therefore, emergency operations may be commenced laparoscopically in selected patients, especially considering the postoperative advantages of this approach.

  4. Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer.

    Science.gov (United States)

    Mafé, Juan J; Planelles, Beatriz; Asensio, Santos; Cerezal, Jorge; Inda, María-Del-Mar; Lacueva, Javier; Esteban, Maria-Dolores; Hernández, Luis; Martín, Concepción; Baschwitz, Benno; Peiró, Ana M

    2017-08-01

    Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use. A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed. One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% vs. 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05). The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.

  5. Tumor deposit is a poor prognostic indicator in patients who underwent simultaneous resection for synchronous colorectal liver metastases

    Directory of Open Access Journals (Sweden)

    Lin Q

    2015-01-01

    Full Text Available Qi Lin,# Ye Wei,# Li Ren,# Yunshi Zhong,# Chunzhi Qin, Peng Zheng, Pingping Xu, Dexiang Zhu, Meiling Ji, Jianmin XuDepartment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China#These authors contributed equally to this workBackground: Tumor deposits are one of the important influencing factors among the different editions of Tumor, Node, Metastasis classification. Incidence and prognosis of tumor deposits in stage I, II, and III colorectal cancer patients has been explored. The aim of this study was to determine the prognostic value of tumor deposits in stage IV colorectal cancer patients who underwent simultaneous resection for synchronous colorectal liver metastases (SCRLM.Methods: Clinicopathological and outcome data of 146 consecutive SCRLM patients who underwent simultaneous R0 resection between July 2003 and July 2013 were collected from our prospectively established SCRLM database. The prognostic value of tumor deposits was evaluated by Kaplan–Meier and Cox regression analysis.Results: Tumor deposits were detected in 41.8% (61/146 of these SCRLM patients. Tumor deposits were significantly correlated with lymph node metastasis and nerve invasion of the primary tumors (P=0.002, P=0.041; respectively. The Kaplan–Meier survival analysis revealed that the overall survival (OS and disease-free survival (DFS of SCRLM patients with tumor deposits were significantly poorer than those with no tumor deposits (P=0.039, P=0.001; respectively. And with multivariate analysis, we found that positive tumor deposits were significantly associated with shorter DFS independent of lymph node status (P=0.002. Subgroup analysis found that of the 57 SCRLM patients with negative lymph node status, the OS and DFS of patients with positive tumor deposits were significantly shorter than those with negative tumor deposits (P=0.002 and P=0.031, respectively. Of the 89 patients with positive lymph node status, the OS of

  6. [ The new 2010 Ghent criteria for the indication to surgical treatment of patients affected by Marfan syndrome. Experience of a single cardiac surgery center].

    Science.gov (United States)

    Grego, Susanna; Nardi, Paolo; Gislao, Valentina; Nicolò, Francesca; D'Annolfo, Antonella; Marcucci, Rosaria; Bovio, Emanuele; Versaci, Francesco; Chiariello, Luigi

    2013-01-01

    The diagnosis and surgical treatment of patients with Marfan syndrome remain controversial. It is of utmost importance to identify patients at risk for acute aortic events to establish the correct surgical timing and the appropriate surgical treatment. From May 2008 to December 2012, 500 patients were screened at the Marfan Presidium of the Tor Vergata University Hospital of Rome (Italy). Patients were evaluated by a cardiac surgeon, including echocardiographic, orthopedic, ophthalmologic and dental examinations. All patients received genetic counseling, and genetic sampling was performed if appropriate. The diagnosis of Marfan syndrome was confirmed in 146 patients (29.2%). Fifty-four patients (37%) underwent cardiac surgery on the aortic root, 4 patients had surgery on the mitral valve, 13 patients had combined surgery; 11 cases were emergent surgery for acute aortic dissection. Twenty-eight patients (52%) were operated on at our Division: 13 underwent valve-sparing aortic root replacement (David procedure), 1 underwent Yacoub remodeling procedure and 14 underwent Bentall procedure. Following the establishment of the Marfan Center, the David aortic valve-sparing operation was the most frequently performed procedure compared to the previous period of surgical activity (63 vs 22%, psyndromes. Early surgical treatment is recommended in these patients to achieve optimal results of valve-sparing procedures and life-saving management, especially for patients who live far away from a cardiac surgery center.

  7. Unmasking sarcoidosis following surgery for Cushing disease

    DEFF Research Database (Denmark)

    Diernæs, Jon Erik; Bygum, Anette; Poulsen, Per L

    2016-01-01

    We present a patient with Cushing disease apparently suppressing sarcoidosis, which was unmasked following surgical resection of a pituitary adrenocorticotropin (ACTH)-producing microadenoma. Case report and a short review of the literature published in this area. A 46-year-old Caucasian woman pr...... successful treatment of Cushing syndrome may have a flare-up or emergence of a corticosteroid-responsive disease.......We present a patient with Cushing disease apparently suppressing sarcoidosis, which was unmasked following surgical resection of a pituitary adrenocorticotropin (ACTH)-producing microadenoma. Case report and a short review of the literature published in this area. A 46-year-old Caucasian woman...... for which the patient underwent transphenoidal resection. Maintenance corticosteroid therapy was implemented, and the signs and symptoms of Cushing disease began to resolve. Three months after surgery, multiple erythematous painful nodules developed on the patient's arms. Erythema nodosum (EN) was diagnosed...

  8. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

    Science.gov (United States)

    Yaldiz, Can; Yaldiz, Mahizer; Ceylan, Nehir; Kacira, Ozlem Kitiki; Ceylan, Davut; Kacira, Tibet; Kizilcay, Gokhan; Tanriverdi, Taner

    2015-07-01

    Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

  9. Risk factors for reintervention after surgery for perforated gastroduodenal ulcer

    DEFF Research Database (Denmark)

    Hasselager, R B; Lohse, N; Duch, P

    2016-01-01

    BACKGROUND: Perforated gastroduodenal ulcer carries a high mortality rate. Need for reintervention after surgical repair is associated with worse outcome, but knowledge on risk factors for reintervention is limited. The aim was to identify prognostic risk factors for reintervention after perforated...... gastroduodenal ulcer in a nationwide cohort. METHODS: All patients treated surgically for perforated gastroduodenal ulcer in Denmark between 2003 and 2014 were included using data from the Danish Clinical Register of Emergency Surgery. Potential risk factors for reintervention were assessed, and their crude...... and adjusted associations calculated by the competing risks subdistribution hazards approach. RESULTS: A total of 4086 patients underwent surgery for perforated gastroduodenal ulcer during the study interval. Median age was 71·1 (i.q.r. 59·6-81·0) years and the overall 90-day mortality rate was 30·8 per cent...

  10. Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases

    Directory of Open Access Journals (Sweden)

    Bor-Seng-Shu Edson

    2004-01-01

    Full Text Available The role of decompressive craniectomy in the treatment of severe posttraumatic cerebral swelling remains quite a controversial issue. To the best of our knowledge, there is no study demonstrating the effect of decompressive craniectomy on cerebral blood flow (CBF velocity by means of transcranial Doppler sonography (TCD. We present two patients who developed traumatic brain swelling and uncontrollable intracranial hypertension with coma and signs of transtentorial herniation. One patient underwent bifrontal, while the second, unilateral, frontotemporoparietal decompressive craniectomy with dural expansion. In both patients, TCD examinations were performed immediately before and after surgery to study the cerebral hemodynamic changes related to the operations. Pre and postoperative TCD examinations demonstrated a significant increase in blood flow velocity in the intracranial arteries in both subjects. In conclusion, our cases suggest that decompressive craniectomy with dural expansion may result in elevation of CBF velocity in patients with massive brain swelling. The increase in CBF velocity appears to occur not only in the decompressed hemisphere, but also on the opposite side.

  11. Financial cost to institutions on patients waiting for gall bladder disease surgery.

    Science.gov (United States)

    Waqas, Ahmed; Qasmi, Shahzad Ahmed; Kiani, Faran; Raza, Ahmed; Khan, Khizar Ishtiaque; Manzoor, Shazia

    2014-01-01

    The aim of this study was to determine the financial costs to institution on patients waiting for gall bladder disease surgery and suggest measures to reduce them. This multi-centre prospective descriptive survey was performed on all patients who underwent an elective cholecystectomy by three consultants at secondary care hospitals in Pakistan between Jan 2010 to Jan 2012. Data was collected on demographics, the duration of mean waiting time, specific indications and nature of disease for including the patients in the waiting list, details of emergency re-admissions while awaiting surgery, investigations done, treatment given and expenditures incurred on them during these episodes. A total of 185 patients underwent elective open cholecystectomy. The indications for listing the patients for surgery were biliary colic in 128 patients (69%), acute cholecystitis in 43 patients (23%), obstructive jaundice in 8 patients (4.5%) and acute pancreatitis in 6 patients (3.2%). 146 (78.9%) and 39 (21.1%) of patients were listed as outdoor electives and indoor emergencies respectively. Of the 185 patients, 54 patients (29.2%) were re-admitted. Financial costs in Pakistani rupees per episode of readmission were 23050 per episode in total and total money spent on all readmissions was Rs. 17,05,700/-. Financial costs on health care institutions due to readmissions in patients waiting for gall bladder disease surgery are high. Identifying patients at risk for these readmissions and offering them early laparoscopic cholecystectomy is very important.

  12. The evaluation of laparoscopic surgery on pregnant patients with ovarian cysts and its effects on pregnancy over the past 5 Years

    Directory of Open Access Journals (Sweden)

    Koki Kurihara

    2018-01-01

    Full Text Available Study Objective: Study Objective: In this research paper, we demonstrate how to increase the success rate of laparoscopic surgery on pregnant patients with an ovarian cyst using rectal probe, SAND balloon, and lowering the insufficient level. Design: The study design wasa retrospective study. Setting: The study was conducted at Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan. Patients: Pregnant patients with an ovarian cyst who underwent laparoscopic surgeries at our institution during the period from January 2011 to December 2016. Materials and Methods: We reviewed 14 cases of pregnant women with ovarian cysts that underwent laparoscopic surgery during the study period by observing and analyzing the patient's characteristics, hospitalization practices, surgical complications, operational procedures, and obstetric outcomes. Main Results: Three cases were emergency surgeries and 11 cases were elective surgeries. In the 14 cases, the gestational age at the time of the surgeries ranged from 6 to 20 weeks. In our studies, we found no systemic complications after the surgery and none of the cases reported any fetal malformation or any fetal growth restriction. Conclusion: In our review, laparoscopic surgery for ovarian cyst during pregnancy was very safe and successful, without any adverse effects on pregnancy outcome.

  13. Metabolic syndrome after laparoscopic bariatric surgery.

    Science.gov (United States)

    Nugent, Clare; Bai, Chunhong; Elariny, Hazem; Gopalakrishnan, Priya; Quigley, Caitlin; Garone, Michael; Afendy, Mariam; Chan, Oscar; Wheeler, Angela; Afendy, Arian; Younossi, Zobair M

    2008-10-01

    Metabolic syndrome (MS) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study was to assess the impact and predictors of bariatric surgery on the resolution of MS. Subjects included 286 patients [age 44.0 +/- 11.5, female 78.2%, BMI 48.7 +/- 9.4, waist circumference 139 +/- 20 cm, AST 23.5 +/- 14.9, ALT 30.0 +/- 20.1, type 2 diabetes mellitus (DM) 30.1% and MS 39.2%] who underwent bariatric surgery. Of the entire cohort, 27.3% underwent malabsorptive surgery, 55.9% underwent restrictive surgery, and 16.8% had combination restrictive-malabsorptive surgery. Mean weight loss was 33.7 +/- 20.1 kg after restrictive surgery (follow up period 298 +/- 271 days), 39.4 +/- 22.9 kg after malabsorptive surgery (follow-up period 306 +/- 290 days), and 28.3 +/- 14.1 kg after combination surgery (follow-up period 281 +/- 239 days). Regardless of the type of bariatric surgery, significant improvements were noted in MS (p values from <0.0001-0.01) as well as its components such as DM (p values from <0.0001-0.0005), waist circumference (p values <0.0001), BMI (p values <0.0001), fasting serum triglycerides (p values <0.0001 to 0.001), and fasting serum glucose (p values <0.0001). Additionally, a significant improvement in AST/ALT ratio (p value = 0.0002) was noted in those undergoing restrictive surgery. Multivariate analysis showed that patients who underwent malabsorptive bariatric procedures experienced a significantly greater percent excess weight loss than patients who underwent restrictive procedures (p value = 0.0451). Percent excess weight loss increased with longer postoperative follow-up (p value <0.0001). Weight loss after bariatric surgery is associated with a significant improvement in MS and other metabolic factors.

  14. Treatment of perforated giant gastric ulcer in an emergency setting.

    Science.gov (United States)

    Kumar, Pradeep; Khan, Hosni Mubarak; Hasanrabba, Safarulla

    2014-01-27

    To study and assess clinical outcomes of various modes of treatment for perforated giant gastric ulcer in an emergency setting. From May 2010 to February 2013, 20 cases of perforated giant gastric ulcer (> 2 cm) were operated on in an emergency setting. All the patients presented with features of peritonitis and were resuscitated aggressively before taking for surgery. In the first 4 cases, primary closure was done after taking a biopsy and among these, the 3(rd) case also underwent partial distal gastrectomy and gastrojejunostomy and the 4(th) case underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy for malignancy. All the remaining 16 cases underwent partial distal gastrectomy and gastrojejunostomy. Among the first 4 cases, 2 had an uneventful recovery and were discharged on the 6(th) postoperative day. The 3(rd) and 4(th) patients developed gastric fistula, leading to prolonged hospitalization. For the 3(rd) patient, conservative management was tried for 1 wk, followed by partial distal gastrectomy and gastrojejunostomy, and he was discharged on the 20(th) day after admission, while the 4(th) patient underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy. Postoperatively, he developed adult respiratory distress syndrome, multiorgan dysfunction syndrome and expired on the 3(rd) postoperative day of the second surgery. All the remaining 16 patients underwent partial distal gastrectomy and gastrojejunostomy and recovered well. Among these, 4 of them were malignant and the remaining were benign ulcers. All had an uneventful recovery. The percentage of malignancy in our series was 30% (6 out of 20 cases). In our study, 86% had an uneventful recovery, complications were seen in about 10%, and mortality was about 5%. In giant gastric ulcer, the chances of malignancy and leak after primary closure are high. So, we feel that partial distal gastrectomy and gastrojejunostomy is better.

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  16. KRAS Mutant Status, p16 and β-catenin Expression May Predict Local Recurrence in Patients Who Underwent Transanal Endoscopic Microsurgery (TEMS) for Stage I Rectal Cancer.

    Science.gov (United States)

    Sideris, Michail; Moorhead, Jane; Diaz-Cano, Salvador; Bjarnason, Ingvar; Haji, Amyn; Papagrigoriadis, Savvas

    2016-10-01

    Transanal endoscopic microsurgery (TEMS) is emerging as an alternative treatment for rectal cancer Stage I. There remains a risk of local recurrence. The Aim of the study was to study the effect of biomarkers in local recurrence for Stage I rectal cancer following TEMS plus or minus radiotherapy. This is a case control study where we compared 10 early rectal cancers that had recurred, against 19 cases with no recurrence, total 29 patients (age=28.25-86.87, mean age=67.92 years, SD=14.91, Male, N=18, Female, N=11). All patients underwent TEMS for radiological Stage I rectal cancer (yT1N0M0 or yT2N0M0) established with combination of magnetic resonance imaging (MRI) and endorectal ultrasound. We prospectively collected all data on tumour histology, morphological features, as well as follow-up parameters. Molecular analysis was performed to identify their status on BRAF, KRAS, p16 O 6 -methylguanine-DNA methyltransferase (MGMT) and β-catenin. Out of 29 specimens analyzed, 19 were KRAS wild type (65.9%) and 10 mutant (34.5%). Recurrence of the tumour was noted in 10 cases (34.5%) from which 60% were pT1 (N=6) and 40% pT2 (N=4). There was a statistically significant association between KRAS mutant status and local recurrence (N=6, p=0.037). P16 expression greater than 5% (mean=10.8%, min=0, max=95) is linked with earlier recurrence within 11.70 months (N=7, p=0.004). Membranous β-catenin expression (N=12, 48%) was also related with KRAS mutant status (p=0.006) but not with survival (p>0.05). BRAF gene was found to be wild type in all cases tested (N=23). KRAS/p16/β-catenin could be used as a combined biomarker for prediction of local recurrence and stratification of the risk for further surgery. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  17. Bariatric surgery insurance requirements independently predict surgery dropout.

    Science.gov (United States)

    Love, Kaitlin M; Mehaffey, J Hunter; Safavian, Dana; Schirmer, Bruce; Malin, Steven K; Hallowell, Peter T; Kirby, Jennifer L

    2017-05-01

    Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; Psurgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, Psurgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  18. Multiple hemorrhages in brain after spine surgery supra- and infra-tentorial components together

    Directory of Open Access Journals (Sweden)

    Baran Yilmaz

    2015-01-01

    Full Text Available Remote cerebellar hemorrhage after cranial and spinal surgeries is a well-documented entity, so far concomitant supra- and infra-tentorial hemorrhage after spine surgery has rarely been reported in the literature. A 57-year-old woman presented with intractable low back pain and severely impaired mobility. One year ago, she underwent lumbar laminectomy and fusion with posterior spinal instrumentation between L2 and S1. She developed adjacent segment disease at the upper level of the instrumented vertebra. She had a revision surgery and underwent posterior laminectomy and fusion with bilateral transpedicular instrumentation between T10 and S1. She had severe headache, somnolence, and left hemiparesia 48 h after the surgery. Her emergent head computed tomography depicted intra-parenchymal hemorrhage in the right parietal lobe accompanying with subarachnoid hemorrhage, bilateral symmetrical cerebellar hemorrhages and pneumocephalus. She was treated nonsurgically and she got better despite some residual deficits. Symptoms including constant headache, nausea, vomiting, impaired consciousness, new onset seizure, and focal neurological deficit after spine surgeries should raise suspicion for intracranial intra-parenchymal hemorrhage.

  19. The effect of ranitidine on postoperative infectious complications following emergency colorectal surgery: a randomized, placebo-controlled, double-blind trial

    DEFF Research Database (Denmark)

    Moesgaard, F; Jensen, L S; Christiansen, P M

    1998-01-01

    AND TREATMENT: One hundred and ninety-four consecutive patients undergoing acute colorectal surgery for perforated and/or obstructed large bowel were randomized in a double-blind fashion to receive ranitidine 100 mg i.v. twice a day commencing at induction of anesthesia and continued for five days (group I...... patients were withdrawn from the study (for reasons such as other diagnosis, refused to continue, medication not given as prescribed). MAIN OUTCOME MEASURES: Patients were observed for signs of infectious complications; such as wound infection, intra-abdominal abscess, septicemia, and pneumonia. RESULTS...

  20. Factors related to postoperative pain among patients who underwent radiofrequency ablation of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Hsieh, Y.-C.; Yap, Y.-S.; Hung, C.-H.; Chen, C.-H.; Lu, S.-N.; Wang, J.-H.

    2013-01-01

    Aim: To evaluate the incidence and associated factors of postoperative intense pain and haemodynamic changes during radiofrequency ablation of hepatocellular carcinoma. Materials and methods: A total of 123 consecutive hepatocellular carcinoma patients who underwent radiofrequency ablation were prospectively recruited. Patient factors, tumour characteristics, procedural factors, intraoperative haemodynamic changes, complications, postoperative events, laboratory values before and after ablation, and postoperative pain were evaluated. Postoperative pain was scored using a visual analogue scale after the procedure. Results: The mean age of the patients was 65.6 ± 9.6 years. In multiple logistic regression analysis, patients who underwent general anaesthesia [odds ratio (95% CI): 2.68 (1.23–5.81); p = 0.013] and had more postoperative nausea and vomiting episodes [3.10 (1.11–8.63); p = 0.036] were associated with intense pain. These findings remain robust after propensity score matching. For mean difference values between before and after RFA, higher in change in aspartate transaminase (p = 0.026), alanine transaminase (p = 0.016) and white blood cell count (p = 0.015), and lower in change in haemoglobin (p = 0.009) were also correlated with intense pain. There was no significant difference in haemodynamic changes between the general anaesthesia and local anaesthesia group during ablation. Conclusion: General anaesthesia, postoperative nausea and vomiting, and laboratory factors were associated with postoperative intense pain in patients who underwent radiofrequency ablation. Counselling and modification of analgesics should be considered in patients with related factors for intense pain

  1. Safety and Tolerability of Transitioning from Cangrelor to Ticagrelor in Patients Who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Badreldin, Hisham A; Carter, Danielle; Cook, Bryan M; Qamar, Arman; Vaduganathan, Muthiah; Bhatt, Deepak L

    2017-08-01

    The 3 phase 3 CHAMPION (Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials collectively demonstrated the safety of transitioning from cangrelor, a potent, parenteral rapidly-acting P2Y 12 inhibitor, to clopidogrel in patients who underwent percutaneous coronary intervention (PCI). However, variation in timing of therapy, site-specific binding, and drug half-lives may theoretically complicate switching to other oral P2Y 12 inhibitors. Since regulatory approval, limited data are available regarding the "real-world" safety and tolerability of transitioning to these more potent oral P2Y 12 antagonists. From November 2015 to January 2017, we evaluated the clinical profiles and efficacy and safety outcomes in cangrelor-treated patients who underwent PCI transitioned to clopidogrel (n = 42) or ticagrelor (n = 82) at a large, tertiary care center. Most patients receiving cangrelor underwent PCI with a drug-eluting stent for acute coronary syndrome via a radial approach in the background of unfractionated heparin. Stent thrombosis within 48 hours was rare and occurred in 1 patient treated with ticagrelor. Global Use of Strategies to Open Occluded Coronary Arteries-defined bleeding occurred in 20% of patients switched to ticagrelor and 29% of patients switched to clopidogrel, but none were severe or life-threatening. In conclusion, rates of stent thrombosis and severe/life-threatening bleeding were low and comparable with those identified in the CHAMPION program, despite use of more potent oral P2Y 12 inhibition. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Surrogate pregnancy in a patient who underwent radical hysterectomy and bilateral transposition of ovaries.

    Science.gov (United States)

    Azem, Foad; Yovel, Israel; Wagman, Israel; Kapostiansky, Rita; Lessing, Joseph B; Amit, Ami

    2003-05-01

    To evaluate IVF-surrogate pregnancy in a patient with ovarian transposition after radical hysterectomy for carcinoma of the cervix. Case report. A maternity hospital in Tel Aviv that is a major tertiary care and referral center. A 29-year-old woman who underwent Wertheim's hysterectomy for carcinoma of the uterine cervix and ovarian transposition before total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to surrogate mother. Outcome of IVF cycle. A twin pregnancy in the first cycle. This is the second reported case of controlled ovarian stimulation and oocyte retrieval performed on a transposed ovary.

  3. [A Case of Ascending Colon Cancer with Lynch Syndrome Who Underwent XELOX Adjuvant Chemotherapy].

    Science.gov (United States)

    Takase, Koki; Murata, Kohei; Kagawa, Yoshinori; Nose, Yohei; Kawai, Kenji; Sakamoto, Takuya; Naito, Atsushi; Murakami, Kohei; Katsura, Yoshiteru; Omura, Yoshiaki; Takeno, Atsushi; Nakatsuka, Shinichi; Takeda, Yutaka; Kato, Takeshi; Tamura, Shigeyuki

    2018-01-01

    Lynch syndrome is an inherited syndrome with the development of the colorectal and various other cancers. Lynch syndrome is caused by mutations in the mismatch repair genes. A 33 year-old male underwent XELOX adjuvant chemotherapy for ascending colon cancer with Lynch syndrome. Although efficacy of 5-FU is not demonstrated in Lynch syndrome, MOSAIC trial had suggested a benefit from FOLFOX compared with 5-FU in patients who have colorectal cancer with Lynch syndrome. Oxaliplatin-based adjuvant chemotherapy can be a therapeutic option for colorectal cancer in lynch syndrome patients.

  4. Evaluation of late redislocation in patients who underwent open reduction and pelvic osteotomy as treament for developmental dysplasia of the hip.

    Science.gov (United States)

    Tuhanioğlu, Ümit; Cicek, Hakan; Ogur, Hasan U; Seyfettinoglu, Firat; Kapukaya, Ahmet

    2017-10-16

    The goal in the treatment of developmental dysplasia of the hip (DDH) is to achieve a stable and concentric reduction and to create a congruent relationship between the femoral head and the acetabulum. This study discusses the causes of loss of reduction in DDH patients who had a concentrically reduced hip at the time of removal of the hip spica cast and cessation of brace use and who later appeared with hip redislocation after mobilisation and ambulation. In addition, the possible interventions in such cases are also discussed. A retrospective evaluation was made of 13 patients diagnosed with DDH who developed redislocation following primary surgery. 6 of them had undergone the 1st surgery in our department between 2008 and 2016 and 7 had udergone surgery in another centre. For comparison reasons a 2nd group was formed of 13 demographically and clinically matched patients who had no loss of reduction. The groups were compared in terms of acetabular index, pelvic length, pelvic width, abduction degree of plaster, ossifying nucleus diameter, acetabular depth, and acetabular volume parameters. The average age of the patients was 23 months at initial surgery and 29 months at the time of revision surgery. No significant difference was found between the groups in terms of acetabular inclination angle, ossifying nucleus diameter, pelvic size, pelvic width, centre edge angle, acetabular volume, and depth. Contracted inferomedial capsule was found in 1 patient who underwent revision surgery and intact transverse acetabular ligament was seen in 1 patient. The loss of reduction in the remaining 11 patients was associated with high total anteversion of the femoral head and acetabulum. Correction of increased combined anteversion by femoral osteotomy can create a safe zone in terms of redislocation and can significantly contribute to the stability provided by capsulorrhaphy and pelvic osteotomy.

  5. EXPERIMENTAL AND CLINICAL STUDY OF PHENOTYPIC FEATURES OF S. EPIDERMIDIS STRAINS AND THEIR ROLE IN THE EMERGENCE AND DEVELOPMENT OF IMPLANT-ASSOCIATED INFECTION AFTER ORTHOPAEDIC SURGERY

    Directory of Open Access Journals (Sweden)

    S. A. Bozhkova

    2014-01-01

    Full Text Available S. epidermidis is one of the most common cause of implant-associated infections. Infections due to S. epidermidis rarely develops into life-threatening, however, its prevalence and the difficulties in treating constitute a serious financial burden to the health care system. This study is based on the investigation of phenotypic features (ability to biofilm formation and resistance to antibiotics of S. epidermidis strains isolated from patients with deep surgical site infection after implantation of orthopaedic devices, and on the investigation of the dynamics of clinical and morphological changes during the development of implant-associated infection due to S. epidermidis based on in vivo experimental models. Multidrug-resistance was found in 23% MSSE isolates and 97,3% - MRSE. Vancomycin, linezolid and fosfomycin were the most active in relation to these pathogens. About 40% of the tested isolates were strong biofilm-producing strains. 43,2% of MRSE strains and only 21,4% of MSSE isolates demonstrated strong biofilm production. The proposed experimental model shows that intra-operative infection of implant by multidrug-resistant clinical MRSE strain led to the development of osteomyelitis in rats for 4 weeks after surgery, in spite of the revision operation and installation of antimicrobial cement spacer in the area of bone defect. Thus, S. epidermidis is a clinically significant aetiological factor with high risk of development of infections after major orthopaedic surgery.

  6. The Prevalence of Ostomy-related Complications 1 Year After Ostomy Surgery: A Prospective, Descriptive, Clinical Study.

    Science.gov (United States)

    Carlsson, Eva; Fingren, Jeanette; Hallén, Anne-Marie; Petersén, Charlotta; Lindholm, Elisabet

    2016-10-01

    Despite advancements in the creation and care of stomas, ostomy and peristomal skin complications are common immediately following surgery as well as in the months and years thereafter. A prospective study to determine the prevalence of ostomy and peristomal skin complications and the influence of ostomy configuration on such complications was conducted 1 year after ostomy surgery among all patients at a university hospital in Sweden. All participants received regular (10 to 14 days post discharge, 6 weeks, 3 months, 6 months, and 1 year post surgery) ostomy follow-up care by a wound ostomy continence (WOC) nurse. All consecutive elective and emergency patients who had undergone surgery to create a colostomy (end colostomy), end ileostomy, or loop ileostomy were eligible to participate. Patients who were reoperated during their first year post-surgery, patients with a urostomy, and patients with double ostomies were excluded from the study. Patient data collected included age, gender, diagnosis, elective or emergency surgery, open or laparoscopic surgical procedure, presence of a colorectal surgeon specialist at surgery, type of ostomy (colostomy, end ileostomy, loop ileostomy), preoperative ostomy siting, counseling, body mass index, American Society of Anesthesiologists classification, and radiation and/or chemotherapy status. Ostomies were evaluated by 4 WOC nurses as to stoma configuration, convexity use, patient self-sufficiency in stoma care, and complications. All 207 patients (53% women) who were eligible agreed to participate in the study. Patient median age was 70 years (range 19-94); 74% underwent elective surgery. Main diagnoses were colorectal cancer (62%) and inflammatory bowel disease (19%). Ostomy types were: colostomy (71%), end ileostomy (26%), and loop ileostomy (3%). One or more complications occurred in 35% of the patients (27% ostomy complications, 11% peristomal skin complications). A colostomy hernia was the most common surgical complication

  7. HLA-G regulatory haplotypes and implantation outcome in couples who underwent assisted reproduction treatment.

    Science.gov (United States)

    Costa, Cynthia Hernandes; Gelmini, Georgia Fernanda; Wowk, Pryscilla Fanini; Mattar, Sibelle Botogosque; Vargas, Rafael Gustavo; Roxo, Valéria Maria Munhoz Sperandio; Schuffner, Alessandro; Bicalho, Maria da Graça

    2012-09-01

    The role of HLA-G in several clinical conditions related to reproduction has been investigated. Important polymorphisms have been found within the 5'URR and 3'UTR regions of the HLA-G promoter. The aim of the present study was to investigate 16 SNPs in the 5'URR and 14-bp insertion/deletion (ins/del) polymorphism located in the 3'UTR region of the HLA-G gene and its possible association with the implantation outcome in couples who underwent assisted reproduction treatments (ART). The case group was composed of 25 ART couples. Ninety-four couples with two or more term pregnancies composed the control group. Polymorphism haplotype frequencies of the HLA-G were determined for both groups. The Haplotype 5, Haplotype 8 and Haplotype 11 were absolute absence in ART couples. The HLA-G*01:01:02a, HLA-G*01:01:02b alleles and the 14-bp ins polymorphism, Haplotype 2, showed an increased frequency in case women and similar distribution between case and control men. However, this susceptibility haplotype is significantly presented in case women and in couple with failure implantation after treatment, which led us to suggest a maternal effect, associated with this haplotype, once their presence in women is related to a higher number of couples who underwent ART. Copyright © 2012. Published by Elsevier Inc.

  8. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

    Directory of Open Access Journals (Sweden)

    Ai-Yun Shen

    2016-10-01

    Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

  10. Emergency Stenting of a Ruptured Infected Anastomotic Femoral Pseudoaneurysm

    International Nuclear Information System (INIS)

    Klonaris, Chris; Katsargyris, Athanasios; Matthaiou, Alexandros; Giannopoulos, Athanasios; Tsigris, Chris; Papadopouli, Katerina; Tsiodras, Sotiris; Bastounis, Elias

    2007-01-01

    A 74-year-old man presented with a ruptured infected anastomotic femoral pseudoaneurysm. Due to severe medical comorbidities he was considered unsuitable for conventional surgical management and underwent an emergency endovascular repair with a balloon-expandable covered stent. The pseudoaneurysm was excluded successfully and the patient had an uneventful postoperative recovery with long-term suppressive antimicrobials. He remained well for 10 months after the procedure with no signs of recurrent local or systemic infection and finally died from an acute myocardial infarction. To our knowledge, emergency endovascular treatment of a free ruptured bleeding femoral artery pseudoaneurysm has not been documented before in the English literature. This case illustrates that endovascular therapy may be a safe and efficient alternative in the emergent management of ruptured infected anastomotic femoral artery pseudoaneurysms when traditional open surgery is contraindicated

  11. Nose Surgery

    Science.gov (United States)

    ... Patient Health Home Copyright © 2018 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly ... Terms of Use © Copyright 2018. American Academy of Otolaryngology — Head and Neck Surgery 1650 Diagonal Rd Alexandria, ...

  12. After Surgery

    Science.gov (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  13. The Burnout on Nurses in ICU, Emergency and Surgery at Teaching Hospital Mazandaran University of Medical Sciences and Relationship with Perceived Stress

    OpenAIRE

    MK Fakhri; A Aslipoor

    2015-01-01

    Abstract Introduction: Nursing Profession is stressful and the stress of the job, it will eventually cause burnout but people's different perception of stressful event can adjust this relation. The purpose of study is to assessment burnout on nurses in ICU, emergency and surgical and relationship with perceived stress. Methods: This is a descriptive analytically cross-sectional study. The population of study were all male and female nurses who are working in 4 teaching hospitals which ...

  14. Thyroid Surgery

    Science.gov (United States)

    ... Hypothyroidism in Children and Adolescents Pediatric Differentiated Thyroid Cancer Thyroid Nodules in Children and Adolescents Thyroid Surgery Resources Thyroid Surgery Brochure PDF Thyroid Surgery FAQs PDF En Español Cirugia De La Tiroides El folleto de Cirugia De La Tiroides Search Thyroid ...

  15. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

    Directory of Open Access Journals (Sweden)

    Atoosa Adibi

    2016-01-01

    Full Text Available Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE who underwent computed tomography pulmonary angiography (CTPA. Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells' criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results. Results: PTE was diagnosed in 53 (17.1% of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05. Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05. Frequency of all criteria of Wells' criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05. The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05. Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences.

  16. Correlation between location of transposed ovary and function in cervical cancer patients who underwent radical hysterectomy.

    Science.gov (United States)

    Yoon, Aera; Lee, Yoo-Young; Park, Won; Huh, Seung Jae; Choi, Chel Hun; Kim, Tae-Joong; Lee, Jeong-Won; Kim, Byoung-Gie; Bae, Duk-Soo

    2015-05-01

    The study investigated the association between the location of transposed ovaries and posttreatment ovarian function in patients with early cervical cancer (IB1-IIA) who underwent radical hysterectomy and ovarian transposition with or without adjuvant therapies. Retrospective medical records were reviewed to enroll the patients with early cervical cancer who underwent ovarian transposition during radical hysterectomy at Samsung Medical Center between July 1995 and July 2012. Serum follicle-stimulating hormone (FSH) level was used as a surrogate marker for ovarian function. Twenty-one patients were enrolled. The median age and body mass index (BMI) were 31 years (range, 24-39 years) and 21.3 kg/m² (range, 17.7-31.2 kg/m²), respectively. The median serum FSH level after treatment was 7.9 mIU/mL (range, 2.4-143.4 mIU/mL). The median distance from the iliac crest to transposed ovaries on erect plain abdominal x-ray was 0.5 cm (range, -2.7 to 5.2 cm). In multivariate analysis, posttreatment serum FSH levels were significantly associated with the location of transposed ovaries (β = -8.1, P = 0.032), concurrent chemoradiation (CCRT) as an adjuvant therapy (β = 71.08, P = 0.006), and BMI before treatment (underweight: β = -59.93, P = 0.05; overweight: β = -40.62, P = 0.041). Location of transposed ovaries, adjuvant CCRT, and BMI before treatment may be associated with ovarian function after treatment. We suggest that ovaries should be transposed as highly as possible during radical hysterectomy to preserve ovarian function in young patients with early cervical cancer who might be a candidate for adjuvant CCRT and who have low BMI before treatment.

  17. Beneficial Effect of the Nutritional Support in Children Who Underwent Hematopoietic Stem Cell Transplant.

    Science.gov (United States)

    Koç, Nevra; Gündüz, Mehmet; Tavil, Betül; Azik, M Fatih; Coşkun, Zeynep; Yardımcı, Hülya; Uçkan, Duygu; Tunç, Bahattin

    2017-08-01

    The aim of this study was to evaluate nutritional status in children who underwent hematopoietic stem cell transplant compared with a healthy control group. A secondary aim was to utilize mid-upper arm circumference as a measure of nutritional status in these groups of children. Our study group included 40 children (18 girls, 22 boys) with mean age of 9.2 ± 4.6 years (range, 2-17 y) who underwent hematopoietic stem cell transplant. Our control group consisted of 20 healthy children (9 girls, 11 boys). The children were evaluated at admission to the hospital and followed regularly 3, 6, 9, and 12 months after discharge from the hospital. In the study group, 27 of 40 patients (67.5%) received nutritional support during hematopoietic stem cell transplant, with 15 patients (56%) receiving enteral nutrition, 6 (22%) receiving total parenteral nutrition, and 6 (22%) receiving enteral and total parenteral nutrition. Chronic malnutrition rate in the study group was 47.5% on admission to the hospital, with the control group having a rate of 20%. One year after transplant, the rate decreased to 20% in the study group and 5% in the control group. The mid-upper arm circumference was lower in children in the study group versus the control group at the beginning of the study (P groups at follow-up examinations (P > .05). During follow-up, all anthropometric measurements increased significantly in both groups. Monitoring nutritional status and initiating appropriate nutritional support improved the success of hematopoietic stem cell transplant and provided a more comfortable process during the transplant period. Furthermore, mid-upper arm circumference is a more sensitive, useful, and safer parameter that can be used to measure nutritional status of children who undergo hematopoietic stem cell transplant.

  18. Following Bariatric Surgery: an Exploration of the Couples' Experience.

    Science.gov (United States)

    Pories, Mary Lisa; Hodgson, Jennifer; Rose, Mary Ann; Pender, John; Sira, Natalia; Swanson, Melvin

    2016-01-01

    Bariatric surgery is the most effective intervention for morbid obesity, resulting in substantial weight loss and the resolution of co-morbid conditions. It is not clear what impact bariatric surgery and the subsequent life-style changes have on patients' couple relationships. The purpose of this phenomenological study was to examine the lived experience of couples after one member of the couple underwent bariatric surgery. This study utilized a phenomenological approach of semi-structured interviews of the couples jointly (n = 10 couples). Colaizzi's method of analysis for phenomenological studies was utilized to elucidate the central themes and distill the essence of the participants' experience. All of the couples felt their post-operative success was due to a joint effort on both members of the couples' part. The participant couples described the following five emerging thematic experiences: (a) changes in physical health, (b) changes in emotional health, (c) changes in eating habits, (d) greater intimacy in the relationship, and (e) the joint journey. This research provides greater insight into the experience of the couple than has been previously reported. The use of qualitative research techniques offer new approaches to examine the biopsychosocial outcomes and needs of bariatric surgery patients. Further research is warranted in order to develop culturally appropriate interventions to improve the patient's surgical and biopsychosocial outcomes.

  19. Risk Factors for Gastrointestinal Leak after Bariatric Surgery: MBASQIP Analysis.

    Science.gov (United States)

    Alizadeh, Reza Fazl; Li, Shiri; Inaba, Colette; Penalosa, Patrick; Hinojosa, Marcelo W; Smith, Brian R; Stamos, Michael J; Nguyen, Ninh T

    2018-03-30

    Gastrointestinal leak remains one of the most dreaded complications in bariatric surgery. We aimed to evaluate risk factors and the impact of common perioperative interventions on the development of leak in patients who underwent laparoscopic bariatric surgery. Using the 2015 database of accredited centers, data were analyzed for patients who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass (LRYGB). Emergent, revisional, and converted cases were excluded. Multivariate logistic regression was used to analyze risk factors for leak, including provocative testing of anastomosis, surgical drain placement, and use of postoperative swallow study. Data from 133,478 patients who underwent laparoscopic sleeve gastrectomy (n = 92,495 [69.3%]) and LRYGB (n = 40,983 [30.7%]) were analyzed. Overall leak rate was 0.7% (938 of 133,478). Factors associated with increased risk for leak were oxygen dependency (adjusted odds ratio [AOR] 1.97), hypoalbuminemia (AOR 1.66), sleep apnea (AOR 1.52), hypertension (AOR 1.36), and diabetes (AOR 1.18). Compared with LRYGB, laparoscopic sleeve gastrectomy was associated with a lower risk of leak (AOR 0.52; 95% CI 0.44 to 0.61; p leak rate was higher in patients with vs without a provocative test (0.8% vs 0.4%, respectively; p leak rate was higher in patients with vs without a surgical drain placed (1.6% vs 0.4%, respectively; p leak rate was similar between patients with vs without swallow study (0.7% vs 0.7%; p = 0.50). The overall rate of gastrointestinal leak in bariatric surgery is low. Certain preoperative factors, procedural type (LRYGB), and interventions (intraoperative provocative test and surgical drain placement) were associated with a higher risk for leaks. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. [Perioperative nursing of internal sinus floor elevation surgery with piezosurgery].

    Science.gov (United States)

    He, Jing; Lei, Yiling; Wang, Liqiong

    2013-12-01

    This study aims to summarize the nursing experience in the internal sinus floor elevation surgery with piezosurgery. The medical records of 48 patients who underwent sinus floor elevation surgery with piezosurgery in the Department of Implantation, West China Hospital of Stomatology, Sichuan University, were reviewed. The preoperative, intraoperative, and postoperative nursing methods were summarized. All 48 patients underwent smooth surgeries and did not encounter complications. Careful preoperative preparation, careful and meticulous intraoperative nursing cooperation, and provision of sufficient health education after surgery to the patients are the key factors that ensure the success of internal sinus floor elevation surgery with piezosurgery.

  1. Cirugía laparoscópica de urgencia en el embarazo ectópico Emergency laparoscopic surgery in ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Ernesto Manuel Luzardo Silveira

    2011-09-01

    Full Text Available Se realizó un estudio descriptivo y prospectivo de 32 pacientes con embarazo ectópico, tratadas por medio de cirugía laparoscópica en el Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba desde enero de 2003 hasta diciembre de 2008. Esa gestación anormal prevaleció en mujeres de 15-31 años, en las trompas (tubárico y en la forma complicada (roto. La técnica quirúrgica fue radical en la totalidad de la serie, lo cual garantizó la pronta recuperación de sus integrantes y el alta hospitalaria precoz, sin aumentar el riesgo de complicaciones.A descriptive and prospective study of 32 patients with ectopic pregnancy treated through laparoscopic surgery at "Dr Joaquín Castillo Duany" Teaching Clinical Surgical Hospital in Santiago de Cuba was carried out from January, 2003 to December, 2008. The abnormal gestation, which prevailed in the Fallopian tubes (uterotubal and in the complicated form (broken, was observed in women aged 15-31 years. Surgical technique was radical in the whole series. This guaranteed to patients their soon recovery as well as their earlier discharge from hospital, without increasing complication risks.

  2. Association of pretreatment neutrophil-lymphocyte ratio and outcome in emergency colorectal cancer care.

    Science.gov (United States)

    Palin, R P; Devine, A T; Hicks, G; Burke, D

    2018-04-01

    Introduction The association between the neutrophil-lymphocyte ratio (NLR) and outcome in elective colorectal cancer surgery is well established; the relationship between NLR and the emergency colorectal cancer patient is, as yet, unexplored. This paper evaluates the predictive quality of the NLR for outcome in the emergency colorectal cancer patient. Materials and Methods A total of 187 consecutive patients who underwent emergency surgery for colorectal cancer were included in the study. NLR was calculated from the haematological tests done on admission. Receiver operating characteristic analyses were used to determine the most suitable cut-off for NLR. Outcomes were assessed by mortality at 30 and 90 days using stepwise Cox proportional hazards regression. Results An NLR cut-off of 5 was found to have the highest sensitivity and specificity. At 30 days, age and time from admission to surgery were associated with increased mortality; a high NLR was associated with an increased risk of mortality in univariate but not multivariate analysis. At 90 days, age, NLR, time from admission to surgery and nodal status were all significantly associated with increased mortality on multivariate analysis. Conclusions Pre-operative NLR is a cheap, easily performed and useful clinical tool to aid prediction of outcome in the emergency colorectal cancer patient.

  3. Nontraumatic Emergency Laparotomy: Surgical Principles Similar to Trauma Need to Be Adopted?

    Science.gov (United States)

    Singh-Ranger, Deepak; Leung, Edmund; Lau-Robinson, Mei-Ling; Ramcharan, Sean; Francombe, James

    2017-11-01

    In 2011, the Royal College of Surgeons published Emergency Surgery: Standards for Unscheduled Care in response to variable clinical outcomes for emergency surgery. The purpose of this study was to examine whether different treatment modalities would alter survival. All patients who underwent emergency laparotomy between April 2011 and December 2012 at Warwick Hospital (Warwick, UK) were included retrospectively. Information relating to their demographics; preoperative score; primary pathology; timing of surgery; intraoperative details; and postoperative outcome, including 30-day mortality, were collated for statistical analysis. In total, 91 patients underwent 97 operations. The median age was 64 years (range 50-90, male:female 1:2). Sixty-five percent of cases were obstruction and perforation, and 66% of all operations were performed during office hours. The unadjusted 30-day mortality was 15.4%. Compared with nonsurvivors, survivors had a significantly higher Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity score ( P < 0.001), prolonged duration of hypotension and use of inotropes ( P = 0.013), higher volume of colloid use ( P = 0.04), and lower core body temperature ( P < 0.05). Grades of surgeons did not influence mortality. The 30-day mortality rate is comparable to the national standard. Further studies are warranted to determine whether trauma management modalities may be adopted to target high-risk patients who exhibit the lethal triad of hypotension, coagulopathy, and hypothermia.

  4. Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC).

    Science.gov (United States)

    Mazzei, Maria Antonietta; Khader, Leila; Cirigliano, Alfredo; Cioffi Squitieri, Nevada; Guerrini, Susanna; Forzoni, Beatrice; Marrelli, Daniele; Roviello, Franco; Mazzei, Francesco Giuseppe; Volterrani, Luca

    2013-12-01

    To evaluate the accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent a peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant chemotherapy to obtain a pre-surgery prognostic evaluation and a prediction of optimal cytoreduction surgery. Pre-HIPEC CT examinations of 43 patients with advanced ovarian cancer after neoadjuvant chemotherapy were analyzed by two radiologists. The PCI was scored according to the Sugarbaker classification, based on lesion size and distribution. The results were compared with macroscopic and histologic data after peritonectomy and HIPEC. To evaluate the accuracy of MDCT to detect and localize peritoneal carcinomatosis, both patient-level and regional-level analyses were conducted. A correlation between PCI CT and histologic values for each patient was searched according to the PCI grading. Considering the patient-level analysis, CT shows a sensitivity, specificity, PPV, NPV, and an accuracy in detecting the peritoneal carcinomatosis of 100 %, 40 %, 93 % 100 %, and 93 %, respectively. Considering the regional level analysis, a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 72 %, 80 %, 66 %, 84 %, and 77 %, respectively were obtained for the correlation between CT and histology. Our results encourage the use of MDCT as the only technique sufficient to select patients with peritoneal carcinomatosis for cytoreductive surgery and HIPEC on the condition that a CT examination will be performed using a dedicated protocol optimized to detect minimal peritoneal disease and CT images will be analyzed by an experienced reader.

  5. Association of PTP1B with Outcomes of Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy.

    Science.gov (United States)

    Rivera Franco, Monica M; Leon Rodriguez, Eucario; Martinez Benitez, Braulio; Villanueva Rodriguez, Luisa G; de la Luz Sevilla Gonzalez, Maria; Armengol Alonso, Alejandra

    2016-01-01

    PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR). Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5%) and overexpression (≥5%). Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR ( P = 0.2). However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens ( P = 0.02). Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B over-expression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

  6. Association of PTP1B with Outcomes of Breast Cancer Patients who Underwent Neoadjuvant Chemotherapy

    Directory of Open Access Journals (Sweden)

    Monica M. Rivera Franco

    2016-01-01

    Full Text Available PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR. Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5% and overexpression (≥5%. Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR (P = 0.2. However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens (P = 0.02. Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B overexpression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

  7. Stress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment.

    Science.gov (United States)

    Cheng, Ching-Yu; Stevenson, Eleanor Lowndes; Yang, Cheng-Ta; Liou, Shwu-Ru

    2018-04-28

    To describe the psychological stress and quality of life experienced by women who underwent fertility treatment in Taiwan. Cross-sectional, correlational study. Recruitment was conducted and questionnaires administered at a reproductive medicine center in Chiayi City, Taiwan. Informed consent to participate was obtained from 126 women who sought fertility treatment at the center. The Chinese Fertility Problem Inventory and Fertility Quality of Life scale were used to measure participants' levels of fertility-related stress and fertility-related quality of life. Descriptive statistics, correlation, and regression analysis were used. Overall, participants reported low levels of fertility-related stress and fertility-related quality of life; however, they had relatively high levels of stress related to need for parenthood. Women who were older, had greater body mass indexes, and consumed coffee regularly had lower fertility-related quality of life. Social and relationship concerns and stress related to need for parenthood were significant predictors of low fertility-related quality of life. In a culture in which childbearing is generally an expectation and an important part of family life, women who experience infertility are at risk to experience fertility-related stress. Social support and family consultation might be offered to improve women's fertility-related quality of life. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  8. NUTRITIONAL ASPECTS AND THE USE OF NUTRITIONAL SUPPLEMENTS BY WOMEN WHO UNDERWENT GASTRIC BYPASS.

    Science.gov (United States)

    Trindade, Elisangela Mara; Gebara, Telma Souza E Silva; Cambi, Maria Paula Carlini; Baretta, Giorgio Alfredo Pedroso

    2017-01-01

    Bariatric surgery is deemed one of the most effective procedures for the treatment of obesity and it aims at the reduction and maintenance of weight loss in long term, as the control of the related comorbidities. Quantify the occurrence of alterations of the gastrointestinal tract, suggestive signs of nutritional deficiencies and the use of supplements in a group of women undergoing bariatric surgery. The sample consisted of women aged 20-65 years submitted to Roux-en-Y gastric bypass with monitoring equal to or higher than 24 months. For the qualitative analysis, the Feeding Frequency Questionnaire was used. In the postoperative period, alopecia was the most reported (79.3%), followed by changes in the texture of the nails, both considered predictive of nutritional deficiencies. Changes in the gastrointestinal tract were described in 86.2%, and episodes of dumping were reported in 65.5%. Qualitative analysis has shown reduced daily consumption of sources of animal and plant proteins. After bariatric surgery can occur flatulence, vomiting and dumping syndrome as the most frequent representative symptoms of digestive functional disorders. Alopecia and nail changes are the most important signs of nutritional deficiency. The use of dietary supplements in the postoperative period is scarce and sporadic. A cirurgia bariátrica é considerada um dos procedimentos mais eficazes para tratamento da obesidade e objetiva a redução e manutenção da perda de peso em longo prazo, assim como, o controle das comorbidades associadas. Quantificar a ocorrência de alterações funcionais do trato gastrointestinal, sinais sugestivos de carências nutricionais e o uso de suplementos em um grupo de mulheres submetidas à cirurgia bariátrica. A amostra foi constituída por mulheres com idades entre 20-65 anos submetidas ao bypass gástrico em Y-de-Roux com seguimento igual ou superior a 24 meses. Para análise qualitativa foi utilizado o Questionário de Frequência Alimentar. No per

  9. Emergency procedures

    International Nuclear Information System (INIS)

    Abd Nasir Ibrahim; Azali Muhammad; Ab Razak Hamzah; Abd Aziz Mohamed; Mohammad Pauzi Ismail

    2004-01-01

    The following subjects are discussed - Emergency Procedures: emergency equipment, emergency procedures; emergency procedure involving X-Ray equipment; emergency procedure involving radioactive sources

  10. Simultaneous surgery in patients with both cardiac and noncardiac diseases

    Directory of Open Access Journals (Sweden)

    Yang Y

    2016-07-01

    Full Text Available Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG, bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%], pulmonary infection and hypoxemia (2, 3.1%, hemorrhage of upper digestive tract (1, 1.6%, incisional infection (3, 4.7%, subphrenic abscess (1, 1.6%, and postoperative acute renal failure and hemofiltration (3, 4.7%. Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible

  11. Aspirin responsiveness changes in obese patients following bariatric surgery.

    Science.gov (United States)

    Norgard, Nicholas B; Monte, Scott V; Fernandez, Stanley F; Ma, Qing

    2017-08-01

    Bariatric surgery has emerged as a promising treatment option for weight loss and to counter the metabolic consequences of obesity. Obesity has been linked to a hyperaggregable state, as well as a blunted response to aspirin. This pilot study assessed the hypothesis that bariatric surgery would lead to an improvement in aspirin-induced platelet inhibition and a reduction in platelet aggregability. Fifteen patients scheduled to undergo bariatric surgery were administered two 7-day courses of aspirin 81 mg: the first course administered before surgery and the second was 3 months following surgery. Platelet aggregation was measured before and after each aspirin course using VerifyNow-Aspirin. The primary endpoint was the change in on-treatment aspirin reactive units (ARU) pre- and postsurgery. Data from bariatric surgery study patients were compared to data of normal weighted subjects gathered in a previous study. Roux-en-Y gastric bypass was performed in 80%, and 20% underwent sleeve gastrectomy. The mean starting body mass index (BMI) was 46.9 kg/m 2 . Patients lost on average 24.5 kg, resulting in a postsurgical BMI of 38.5 kg/m 2 . Postbariatric surgery, off-treatment ARU was significantly reduced from presurgery levels (602±59 vs 531±78; P=.035). On-aspirin platelet reactivity was also significantly reduced following surgery (469±60 vs 432±143, P=.03). There was a significant correlation between the extent of weight loss and the degree of improvement in on-aspirin platelet reactivity (r 2 =.49, P=.024). Presurgery on-aspirin platelet reactivity was significantly higher in obese patients compared to normal weighted subjects (469±60 vs 419±52; P=.016) and reduced to the baseline after the surgery (432±63 vs 419±52; P=.54). Aspirin-induced platelet inhibition may be more potent following bariatric surgery. The mechanisms behind this improvement require further investigation. © 2017 John Wiley & Sons Ltd.

  12. Emergency surgical airway management in Denmark

    DEFF Research Database (Denmark)

    Rosenstock, C V; Nørskov, A K; Wetterslev, J

    2016-01-01

    for difficult airway management. RESULTS: In the DAD cohort 27 out of 452 461 patients had an ESA representing an incidence of 0.06 events per thousand (95% CI; 0.04 to 0.08). A total of 12 149/452 461 patients underwent Ear-Nose and Throat (ENT) surgery, giving an ESA incidence among ENT patients of 1.6 events...... of which three failed. Reviewers evaluated airway management as satisfactory in 10/27 patients. CONCLUSIONS: The incidence of ESA in the DAD cohort was 0.06 events per thousand. Among ENT patients, the ESA Incidence was 1.6 events per thousand. Airway management was evaluated as satisfactory for 10......BACKGROUND: The emergency surgical airway (ESA) is the final option in difficult airway management. We identified ESA procedures registered in the Danish Anaesthesia Database (DAD) and described the performed airway management. METHODS: We extracted a cohort of 452 461 adult patients undergoing...

  13. Association between ambient air pollution and pregnancy rate in women who underwent IVF.

    Science.gov (United States)

    Choe, S A; Jun, Y B; Lee, W S; Yoon, T K; Kim, S Y

    2018-04-05

    Are the concentrations of five criteria air pollutants associated with probabilities of biochemical pregnancy loss and intrauterine pregnancy in women? Increased concentrations of ambient particulate matter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO) during controlled ovarian stimulation (COS) and after embryo transfer were associated with a decreased probability of intrauterine pregnancy. Exposure to high ambient air pollution was suggested to be associated with low fertility and high early pregnancy loss in women. Using a retrospective cohort study design, we analysed 6621 cycles of 4581 patients who underwent one or more fresh IVF cycles at a fertility centre from January 2006 to December 2014, and lived in Seoul at the time of IVF treatment. To estimate patients' individual exposure to air pollution, we computed averages of hourly concentrations of five air pollutants including PM10, NO2, CO, sulphur dioxide (SO2) and ozone (O3) measured at 40 regulatory monitoring sites in Seoul for each of the four exposure periods: period 1 (start of COS to oocyte retrieval), period 2 (oocyte retrieval to embryo transfer), period 3 (embryo transfer to hCG test), and period 4 (start of COS to hCG test). Hazard ratios (HRs) from the time-varying Cox-proportional hazards model were used to estimate probabilities of biochemical pregnancy loss and intrauterine pregnancy for an interquartile range (IQR) increase in each air pollutant concentration during each period, after adjusting for individual characteristics. We tested the robustness of the result using generalised linear mixed model, accounting for within-woman correlation. Mean age of the women was 35 years. Average BMI was 20.9 kg/m2 and the study population underwent 1.4 IVF cycles on average. Cumulative pregnancy rate in multiple IVF cycles was 51.3% per person. Survival analysis showed that air pollution during periods 1 and 3 was generally associated with IVF outcomes. Increased NO2 (adjusted HR = 0.93, 95% CI

  14. Errors and complications in laparoscopic surgery

    OpenAIRE

    Liviu Drăghici; Mircea Lițescu; Rubin Munteanu; Constantin Pătru; Carmen L. Gorgan; Radu Mirică; Isabela Drăghici

    2017-01-01

    Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during...

  15. A Case Series of Patients Who Underwent Laparoscopic Extraperitoneal Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Focus on Penile Length Preservation

    Science.gov (United States)

    2018-01-01

    Purpose There are many grey areas in the field of penile rehabilitation after radical prostatectomy (RP). The preservation of the full dimensions of the penis is an important consideration for improving patients' compliance for the treatment. We present the first case series of patients treated by laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) in order to preserve the full length of the penis and to improve patients' satisfaction. Materials and Methods From June 2013 to June 2014, 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis) and RP. Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each 6 months thereafter. The main outcome measures were biochemical recurrence-free rate, penile length, and quality of life. Results Ten patients (mean age of 61 years; completed the study follow-up period (median, 32.2 months). No difference was found between the time of surgery and the 2-year follow-up evaluation in terms of penile length. The pre-surgery 36-Item Short Form Health Survey (SF-36) median score was 97. Patients were satisfied with their penile implants, and couples' level of sexual satisfaction was rated median 8. The median postoperative SF-36 score was 99 at 3 months follow-up. Conclusions Laparoscopic extraperitoneal RP surgery with simultaneous PPI placement seems to be an interesting possibility to propose to motivated patients for preserving the length of the penis and improving their satisfaction. PMID:29623695

  16. [Damage control in field surgery].

    Science.gov (United States)

    Samokhvalov, I M; Manukovskiĭ, V A; Badalov, V I; Severin, V V; Golovko, K P; Denisenko, V V

    2011-09-01

    Damage control surgery (DCS) is an important option in the store of war surgery and surgery of trauma. The main purpose of our investigation was to specify the percentage of the injured who need DCS. We performed retrospective study of the patients in the combat operations in Chechnya (1994-2002) and in peacetime (2005-2010). Total lethality in group with the standard surgical approach was 62.3%. It was significantly higher than the lethality in group of patients who underwent DCS - 50.0% (p < 0.05). Thus, the experience of DCS in War Surgery Department confirms that DCS is perspective tendency in treatment of patients with severe and extremely severe trauma, and allows decreasing lethality in 12.3%.

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ...

  18. Quality of life in locally advanced prostate cancer patients who underwent hormonal treatment combined with radiotherapy

    International Nuclear Information System (INIS)

    Koga, Hirofumi; Naito, Seiji; Fukui, Iwao; Tsukamoto, Taiji; Matsuoka, Naoki; Fujimoto, Hiroyuki

    2004-01-01

    The aim of this study is to estimate the feasibility of quality of life (QOL) research and to evaluate the QOL prospectively in locally advanced prostate cancer patients treated with hormonal treatment combined with radiotherapy. The treatment schedule was that patients with decreasing prostatic specific antigen (PSA) levels below 10 ng/ml after receiving 6 months of neoadjuvant hormonal treatment were randomly divided into two groups; one group was the continuous hormonal treatment group and the other was the intermittent hormonal treatment group. Both groups received a total dose of 72 Gy external beam radiotherapy with concomitant hormonal treatment followed by 6 months of adjuvant hormonal treatment following radiotherapy. At 14 months, patients either underwent continuous or intermittent hormonal treatment according to the random allocation. QOL was assessed at baseline, and at 6, 8, 14, and 20 months after treatment using functional assessment of cancer treatment-general (FACT-G), P with the other 3 items comprising bother of urination, bother of bowel movement, and bother of sexual activity. Between January 2000 and June 2003, a total of 188 patients were enrolled in this study. The rate of collection of baseline QOL sheets was 98.0%. The rate of answer to questions of QOL sheets was 99.0%. At baseline, the average score of FACT-G, P was 120.7 and the maximum score was more than twice the minimum score. Dysfunction of urination and bowel movement was correlated with the bother of urination and bowel movement, respectively. On the other hand, dysfunction of sexual activity was not correlated with the bother of sexual activity. In June 2003, all of the QOL sheets at baseline, and at 6, 8, and 14 months were completely collected from a total of 72 patients. Although QOL at 8 months was significantly affected compared with QOL at baseline and at 6 months, QOL at 14 months was significantly improved compared with that at 8 months and there was no significant

  19. Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction.

    Science.gov (United States)

    Mah, Deuk-Hyun; Kim, Su-Gwan; Oh, Ji-Su; You, Jae-Seek; Jung, Seo-Yun; Kim, Won-Gi; Yu, Kyung-Hwan

    2017-02-01

    The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO). The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding). The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was 2.23±0.92 mm ( P surgery-first orthognathic approach group from T1 to T2 was 3.49±1.71 mm ( P surgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.

  20. C-Reactive protein level in morbidly obese patients before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    M.E. Rojano-Rodríguez

    2014-04-01

    Conclusions: Preoperative CRP had a significant lineal relation to weight and body mass index. Patients who underwent bariatric surgery had a significant decrease in CRP, weight, and fasting glucose at 6 months after surgery.

  1. Kosovo’s Experience for Children with Feeding Difficulties after Cardiac Surgery for Congenital Heart Defect

    Directory of Open Access Journals (Sweden)

    Ramush Bejiqi

    2017-11-01

    CONCLUSION: Feeding disorder is often and a frequent long-term sequel in children after neonatal or early infancy heart surgery. Patients with chromosomal and associated anomalies who underwent multiple cardiac surgeries are at risk of developing feeding difficulties.

  2. Effects of maxillary sinus floor elevation surgery on maxillary sinus physiology

    NARCIS (Netherlands)

    Timmenga, NM; Raghoebar, GM; Liem, RSB; van Weissenbruch, R; Manson, WL; Vissink, A

    In a prospective study, the effects of elevation surgery of the maxillary sinus floor on maxillary sinus physiology were assessed. Seventeen consecutive patients without preoperative anamnestic, clinical and radiological signs of maxillary sinusitis underwent sinus floor elevation surgery with iliac

  3. GENERAL SURGERY

    African Journals Online (AJOL)

    in the endoscopy room. GENERAL SURGERY. T du Toit, O C Buchel, S J A Smit. Department of Surgery, University of the Free State, Bloemfontein, ... The lack of video instrumentation in developing countries: Redundant fibre-optic instruments (the old. “eye scope”) are still being used. This instrument brings endoscopists ...

  4. GENERAL SURGERY

    African Journals Online (AJOL)

    mean time to first surgery post burn was 11.5 days with a median volume of 0.73 mls/kg/% ..... Mode. Mean (SD). Upper limit. 95% CI. Lower limit. 95% CI. Mode. Elective surgery .... evaluating single-unit red blood cell transfusions in reducing.

  5. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed......ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  6. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Berna Dogan

    2016-01-01

    Full Text Available Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG. Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40 who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT, total macular volume (TMV, and retinal ganglion cell layer (RGCL were measured by spectral-domain optical coherence tomography (SD-OCT. Subfoveal choroidal thickness (SFCT was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT. Results. The mean CMT was 237.4±24.5 μm, 239.3±24.1 μm, and 240.4±24.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean TMV was 9.88±0.52 mm3, 9.96±0.56 mm3, and 9.99±0.56 mm3 preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean RGCL was 81.2±6.5 μm, 82.7±6.6 μm, and 82.9±6.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean SFCT was 309.8±71.8 μm, 331.0±81.4 μm, and 352.7±81.4 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p=0.34, disc area (p=0.64, vertical cup/disc ratio (p=0.39, cup volume (p=0.08, or retinal nerve fiber layer (p=0.90. Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery.

  7. The current status of emergency operations at a high-volume cancer center.

    Science.gov (United States)

    Komori, Koji; Kimura, Kenya; Kinoshita, Takashi; Ito, Seiji; Abe, Tetsuya; Senda, Yoshiki; Misawa, Kazunari; Ito, Yuichi; Uemura, Norihisa; Natsume, Seiji; Kawai, Ryosuke; Kawakami, Jiro; Asano, Tomonari; Iwata, Yoshinori; Kurahashi, Shintaro; Tsutsuyama, Masayuki; Shigeyoshi, Itaru; Shimizu, Yasuhiro

    2014-01-01

    This study aimed to assess the pathogenic causes, clinical conditions, surgical procedures, in-hospital mortality, and operative death associated with emergency operations at a high-volume cancer center. Although many reports have described the contents, operative procedures, and prognosis of elective surgeries in high-volume cancer centers, emergency operations have not been studied in sufficient detail. We retrospectively enrolled 28 consecutive patients who underwent emergency surgery. Cases involving operative complications were excluded. The following surgical procedures were performed during emergency operations: closure in 3 cases (10.7%), diversion in 22 cases (78.6%), ileus treatment in 2 cases (7.1%), and hemostasis in 1 case (3.6%). Closure alone was performed only once for peritonitis. Diversion was performed in 17 cases (77.3%) of peritonitis, 4 cases (18.2%) of stenosis of the gastrointestinal tract, and 1 case (4.5%) of bleeding. There was a significant overall difference (P = 0.001). The frequency of emergency operations was very low at a high-volume cancer center. However, the recent shift in treatment approaches toward nonoperative techniques may enhance the status of emergency surgical procedures. The results presented in this study will help prepare for emergency situations and resolve them as quickly and efficiently as possible.

  8. Urgent surgery for complicated colonic diverticula.

    Science.gov (United States)

    Funariu, Gheorghe; Binţinţan, Vasile; Seicean, Radu

    2006-03-01

    The AIM of this retrospective study was to evaluate the emergency surgical treatment of life-threatening complications of colonic diverticula. In the last 11 years, 22 of 101 patients with colonic diverticula (22.1%) underwent urgent surgery for acute complications: perforated gangrenous diverticulitis with generalized peritonitis (n=8) or pericolic abscess (n=8), acute bowel obstruction (n=4) and severe diverticular bleeding (n=2). In all patients with diffuse peritonitis or acute obstruction the indication for surgery was decided on clinical basis and the complicated diverticula were recognized only intra-operatively. Emergency surgical strategy differed according to the type of complication and the biologic condition of the patient: segmental colectomy and primary anastomosis for diverticular perforation (n=4), colonic stenosis (n=3) or diverticular bleeding (n=2); Hartmann resection with late reconnecting anastomosis in patients with diverticular perforation (n=5) or colonic obstruction (n=1); diverticulectomy with peritoneal drainage (n=2) and colostomy and drainage followed by secondary colectomy (n=5) for diverticular perforations in patients with poor general condition. Only one patient (4.5%) died post-operatively of multiple organ failure from generalized peritonitis. There was no anastomotic leakage in patients with primary anastomosis. Six patients (27.2%) developed wound infection. Hospital stay ranged between 11 and 60 days, significantly longer in cases with two-stage operations. Primary colectomy with immediate or delayed anastomosis is the best surgical procedure for acute divericular complications in patients with good biologic status. Two-stage operations such as colostomy and drainage coupled with late colectomy remain the viable alternative in patients with advanced disease and critical biologic condition.

  9. Endoscopic surgery of nasopharyngeal angiofibroma

    Directory of Open Access Journals (Sweden)

    Machado, Silvio

    2010-06-01

    Full Text Available Introduction: Juvenile nasopharyngeal angiofibroma (NAJ is a tumor with vascular component, slow growing, benign but very aggressive because of its local invasiveness. The NAJ is rare, accounting for 0.05% of all head and neck cancers. The classic triad of epistaxis, unilateral nasal obstruction and a mass in the nasopharynx suggests the diagnosis of NAJ and is then supplemented by imaging. Over the past 10 years the treatment of this disease has been discussed with the aim of designing a management protocol. Currently, surgery appears to be the best treatment of the NAJ. Other methods such as hormone therapy, radiotherapy and chemotherapy treatment modalities are now used occasionally as complementary treatments. Objective: To present the cases of this disease in the Hospital Infantil between October 2007 and August 2008. Methods: A retrospective case study of five cases of NAJ underwent surgery solely with endoscopic technique of two surgeons. Classifieds between IIA and IIIA. All patients underwent angiography with embolization of the tumor 3-4 days before surgery. Follow-up after surgery to detect recurrence. Results: There were two relapses in the following two years after surgery. Conclusion: Given the short period of patient follow-up, there were only two relapses in one year. So there is need for further action to claim that this technique has a low recurrence rate, since the recurrence is probably related to incomplete resection the initial tumor.

  10. Target vessel detection by epicardial ultrasound in off-pump coronary bypass surgery.

    Science.gov (United States)

    Hayakawa, Masato; Asai, Tohru; Kinoshita, Takeshi; Suzuki, Tomoaki; Shiraishi, Shoichiro

    2013-01-01

    The detection of embedded coronary arteries is difficult especially in off-pump coronary bypass surgery. From June 2010, we introduced high-frequency epicardial ultrasound (ECUS) to assess and evaluate embedded arteries during off-pump coronary bypass surgery. Between June 2010 and June 2011, a total of 89 consecutive patients underwent isolated coronary bypass surgery at our institution. The patients consisted of 72 men and 17 women with a mean age of 67.9 years. We routinely use the VeriQC system (MediStim, Oslo, Norway) to detect the target vessels in the operation. The patients were assigned to one of two groups, depending on whether ECUS was used in the operation (n = 10, ECUS group) or not (n = 79, non-ECUS group). We analyzed the impact of introducing the ECUS in terms of operative outcome. All patients underwent revascularization using the off-pump technique without emergent conversion to cardiopulmonary bypass during surgery. The total number of distal anastomoses was 299, and 12 target vessels could not be identified either visually or on palpation. Thus, the frequency of the embedded coronary arteries was 4.01% (12/299 cases). The preoperative profiles of the two groups were not significantly different. Operation time was significantly longer in the ECUS group (P = 0.02). There were no significant differences in postoperative outcome between the two groups. In the present study, in which the target coronary arteries could not be detected either visually or on palpation in 12 (4.01%) of 299 cases, the use of high-frequency ECUS allowed all patients to undergo off-pump coronary bypass surgery without conversion to cardiopulmonary bypass during the operation. High-frequency ECUS is therefore useful in off-pump coronary bypass surgery.

  11. Mental illness in bariatric surgery: A cohort study from the PORTAL network.

    Science.gov (United States)

    Fisher, David; Coleman, Karen J; Arterburn, David E; Fischer, Heidi; Yamamoto, Ayae; Young, Deborah R; Sherwood, Nancy E; Trinacty, Connie Mah; Lewis, Kristina H

    2017-05-01

    To compare bariatric surgery outcomes according to preoperative mental illness category. Electronic health record data from several US healthcare systems were used to compare outcomes of four groups of patients who underwent bariatric surgery in 2012 and 2013. These included the following: people with (1) no mental illness, (2) mild-to-moderate depression or anxiety, (3) severe depression or anxiety, and (4) bipolar, psychosis, or schizophrenia spectrum disorders. Groups were compared on weight loss trajectory using generalized estimating equations using B-spline bases and on all-cause emergency department visits and hospital days using zero-inflated Poisson and negative binomial regression up to 2 years after surgery. Models were adjusted for demographic and health covariates, including baseline healthcare use. Among 8,192 patients, mean age was 44.3 (10.7) years, 79.9% were female, and 45.6% were white. Fifty-seven percent had preoperative mental illness. There were no differences between groups for weight loss, but patients with preoperative severe depression or anxiety or bipolar, psychosis, or schizophrenia spectrum disorders had higher follow-up levels of emergency department visits and hospital days compared to those with no mental illness. In this multicenter study, mental illness was not associated with differential weight loss after bariatric surgery, but additional research could focus on reducing acute care use among these patients. © 2017 The Obesity Society.

  12. Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?

    Science.gov (United States)

    Klinginsmith, Michael; Jolley, Jennifer; Lomelin, Daniel; Krause, Crystal; Heiden, Jace; Oleynikov, Dmitry

    2016-05-01

    Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 % were performed laparoscopically and 15.3 % open. 24.6 % of cases were classified urgent/emergent upon admission, and almost 70 % of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 % of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 % LHR vs. 26.3 % OHR). Almost 90 % of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. We demonstrate that laparoscopic PEH repair has become accepted in emergent cases. Open PEH repair is often reserved for emergent surgeries and less commonly includes an AR procedure. Laparoscopy with an AR procedure is clearly the standard of care in elective surgery. The decision to perform an open or laparoscopic surgery, with or without adjunctive techniques, may be based more on the physician's comfort with laparoscopic surgery and surgical practices than the patient's condition. Long-term follow-up studies are

  13. Irradiation followed by muscle surgery for dysthyroid ophthalmopathy with diplopia

    Energy Technology Data Exchange (ETDEWEB)

    Nakajima, Satoko; Asakura, Akiko [Iwate Prefectural Central Hospital, Morioka (Japan); Ogasawara, Kosuke; Mori, Toshiro; Shibuya, Masako; Kurihara, Hideo; Tazawa, Yutaka

    1995-10-01

    We obtained favorable therapeutic outcome in 12 cases of dysthyroid ophthalmopathy with diplopia. All the patients underwent Lineac irradiation to the retrobulbar tissue totalling 15 to 20 Gy over 10 days. Extraocular muscle surgery was performed 30 days after irradiation. Diplopia at the primary position almost disappeared one day after surgery. An additional surgery was necessary in one case. The interval between onset of diplopia and surgery averaged 6.1 months. Irradiation prior to muscle surgery appeared to be beneficial in allowing an early surgery and in avoiding surgical overcorrection. (author).

  14. Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial.

    Science.gov (United States)

    Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Chou, Shih-Wei; Chen, Ching-Yen; Yang, Ching-Tzu

    2016-04-01

    the 2-year follow-up. Comprehensive care, with enhanced rehabilitation, management of malnutrition and depressive symptoms, and fall prevention, improved self-care ability and decreased emergency department visits for elders up to 2 years after hip-fracture surgery, above and beyond the effects of usual care and interdisciplinary care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Study of problems with appendicitis in children undergoing laparoscopic surgery

    International Nuclear Information System (INIS)

    Kosumi, Takuya; Yonekura, Takeo; Yamauchi, Katsuji; Kuroda, Seika; Kimura, Takuya; Ihara, Yoshiyuki

    2011-01-01

    Seventy-one children who underwent laparoscopic appendectomy over the 8 years previous to the study were investigated. The patients were divided into 2 groups: those who had undergome surgery within 24 hours (EA group) and after conservative treatment (IA group). The condition of appendicitis on CT was classified into appendiceal mass (Group A), perforation (Group B), and non-perforation (Group C). Perioperative complications were mainly investigated in these groups. The EA group included 45 patients, and postoperative complications occurred in 2 of 12 patients in Group A (wound infection and intraperitoneal abscess in 1 each) and 2 of 14 patients in Group B (postoperative ileus and intraperitoneal abscess in 1 each). The IA group included 26 patients, and complications occurred only during conservative treatment in 2 of 7 patients in Group A (recurrence of inflammation and ileus in 1 each) and 2 of 2 patients in Group B (recurrence of inflammation and emergency surgery for the aggravation of symptoms in 1 each). No complication occurred in Group C of either the EA or IA group. Treatment was not switched to laparotomy in any patient in the EA or IA group, and no complication occurred during surgery. The total duration of hospitalization was shorter in the EA than in the IA group in all Groups A, B, and C. The risk of postoperative complications was high in the EA group, whereas complications during conservative treatment were problematic in the IA group. (author)

  16. Cataract Surgery

    Science.gov (United States)

    ... Oncology Oculoplastics/Orbit Refractive Management/Intervention Retina/Vitreous Uveitis Focus On Pediatric Ophthalmology ... Are Cataracts? Pediatric Cataracts Cataract Diagnosis and Treatment Cataract Surgery IOL Implants: Lens Replacement After Cataracts ...

  17. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  18. Foot Surgery

    Science.gov (United States)

    ... coding trends along with compliance guidelines and practice marketing materials, APMA has you covered whether you are ... crutches after the surgery or in a cast. Fusions: Fusions are usually performed to treat arthritic or ...

  19. Hemorrhoid surgery

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002939.htm Hemorrhoid surgery To use the sharing features on this page, please enable JavaScript. Hemorrhoids are swollen veins around the anus. They may ...

  20. PLASTIC SURGERY

    African Journals Online (AJOL)

    Department of Plastic and Reconstructive Surgery Sefako Makgatho Health Science University, ... We report on a pilot study on the use of a circumareolar excision and the use of .... and 1 gynecomastia patient) requested reduction in NAC size.

  1. GENERAL SURGERY

    African Journals Online (AJOL)

    influence medical students in pursuing a career in surgery. ... training, females reported significantly higher levels of agreement that surgical training would be better overseas when ..... mentoring surgical research or educational lectures and.

  2. GENERAL SURGERY

    African Journals Online (AJOL)

    1 Department of Surgery, Nelson R Mandela School of Medicine, University of ... in 51 reports. Four reports were illegible; one was conducted by a junior consultant, two by a fourth year trainee specialist ... The study period was 12 months from.

  3. Sinus Surgery

    Science.gov (United States)

    ... sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected ... altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult. Image ...

  4. Incidence and hospital mortality of vascular surgery patients with ...

    African Journals Online (AJOL)

    Central Hospital (IALCH) intensive care unit (ICU) following vascular surgery between 1 January ... patients have a perioperative myocardial infarction (PMI) and 4.6 .... Emergency surgery was performed in 17.8% of the ..... area is needed.

  5. The preoperative plasma fibrinogen level is an independent prognostic factor for overall survival of breast cancer patients who underwent surgical treatment.

    Science.gov (United States)

    Wen, Jiahuai; Yang, Yanning; Ye, Feng; Huang, Xiaojia; Li, Shuaijie; Wang, Qiong; Xie, Xiaoming

    2015-12-01

    Previous studies have suggested that plasma fibrinogen contributes to tumor cell proliferation, progression and metastasis. The current study was performed to evaluate the prognostic relevance of preoperative plasma fibrinogen in breast cancer patients. Data of 2073 consecutive breast cancer patients, who underwent surgery between January 2002 and December 2008 at the Sun Yat-sen University Cancer Center, were retrospectively evaluated. Plasma fibrinogen levels were routinely measured before surgeries. Participants were grouped by the cutoff value estimated by the receiver operating characteristic (ROC) curve analysis. Overall survival (OS) was assessed using Kaplan-Meier analysis, and multivariate Cox proportional hazards regression model was performed to evaluate the independent prognostic value of plasma fibrinogen level. The optimal cutoff value of preoperative plasma fibrinogen was determined to be 2.83 g/L. The Kaplan-Meier analysis showed that patients with high fibrinogen levels had shorter OS than patients with low fibrinogen levels (p factor for OS in breast cancer patients (HR = 1.475, 95% confidence interval (CI): 1.177-1.848, p = 0.001). Subgroup analyses revealed that plasma fibrinogen level was an unfavorable prognostic parameter in stage II-III, Luminal subtypes and triple-negative breast cancer patients. Elevated preoperative plasma fibrinogen was independently associated with poor prognosis in breast cancer patients and may serve as a valuable parameter for risk assessment in breast cancer patients. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Extra-Thoracic Supra-aortic Bypass Surgery Is Safe in Thoracic Endovascular Aortic Repair and Arterial Occlusive Disease Treatment.

    Science.gov (United States)

    Gombert, Alexander; van Issum, Lea; Barbati, Mohammad E; Grommes, Jochen; Keszei, Andras; Kotelis, Drosos; Jalaie, Houman; Greiner, Andreas; Jacobs, Michael J; Kalder, Johannes

    2018-04-20

    The safety and feasibility of supra-aortic debranching as part of endovascular aortic surgery or as a treatment option for arterial occlusive disease (AOD) remains controversial. The aim of this study was to assess the clinical outcome of this surgery. This single centre, retrospective study included 107 patients (mean age 69.2 years, 38.4% women) who underwent supra-aortic bypass surgery (carotid-subclavian bypass, carotid-carotid bypass, and carotid-carotid-subclavian bypass) because of thoracic or thoraco-abdominal endovascular aortic repair (57%; 61/107) or as AOD treatment (42.9%; 46/107) between January 2006 and January 2015. Mortality, morbidity with a focus on neurological complications, and patency rate were assessed. Twenty-six of 107 (14.2%) of the debranching patients were treated under emergency conditions because of acute type B dissection or symptomatic aneurysm. Follow up, conducted by imaging interpretation and telephone interviews, continued till March 2017 (mean 42.1, 0-125, months). The in hospital mortality rate was 10.2% (11/107), all of these cases from the debranching group and related to emergency procedures (p supra-aortic bypass surgery involves low complication rates and high mid-term bypass patency rates. It is a safe and feasible treatment option in the form of debranching in combination with endovascular aortic aneurysm repair and in AOD. Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

  7. Pre-operative assessment of patients undergoing endoscopic, transnasal, transsphenoidal pituitary surgery.

    Science.gov (United States)

    Lubbe, D; Semple, P

    2008-06-01

    To demonstrate the importance of pre-operative ear, nose and throat assessment in patients undergoing endoscopic, transsphenoidal surgery for pituitary tumours. Literature pertaining to the pre-operative otorhinolaryngological assessment and management of patients undergoing endoscopic anterior skull base surgery is sparse. We describe two cases from our series of 59 patients undergoing endoscopic pituitary surgery. The first case involved a young male patient with a large pituitary macroadenoma. His main complaint was visual impairment. He had no previous history of sinonasal pathology and did not complain of any nasal symptoms during the pre-operative neurosurgical assessment. At the time of surgery, a purulent nasal discharge was seen emanating from both middle meati. Surgery was abandoned due to the risk of post-operative meningitis, and postponed until the patient's chronic rhinosinusitis was optimally managed. The second patient was a 47-year-old woman with a large pituitary macroadenoma, who presented to the neurosurgical department with a main complaint of diplopia. She too gave no history of previous nasal problems, and she underwent uneventful surgery using the endoscopic, transnasal approach. Two weeks after surgery, she presented to the emergency unit with severe epistaxis. A previous diagnosis of hereditary haemorrhagic telangiectasia was discovered, and further surgical and medical intervention was required before the epistaxis was finally controlled. Pre-operative otorhinolaryngological assessment is essential prior to endoscopic pituitary or anterior skull base surgery. A thorough otorhinolaryngological history will determine whether any co-morbid diseases exist which could affect the surgical field. Nasal anatomy can be assessed via nasal endoscopy and sinusitis excluded. Computed tomography imaging is a valuable aid to decisions regarding additional procedures needed to optimise access to the pituitary fossa.

  8. ROBOTIC SURGERY: BIOETHICAL ASPECTS.

    Science.gov (United States)

    Siqueira-Batista, Rodrigo; Souza, Camila Ribeiro; Maia, Polyana Mendes; Siqueira, Sávio Lana

    2016-01-01

    The use of robots in surgery has been increasingly common today, allowing the emergence of numerous bioethical issues in this area. To present review of the ethical aspects of robot use in surgery. Search in Pubmed, SciELO and Lilacs crossing the headings "bioethics", "surgery", "ethics", "laparoscopy" and "robotic". Of the citations obtained, were selected 17 articles, which were used for the preparation of the article. It contains brief presentation on robotics, its inclusion in health and bioethical aspects, and the use of robots in surgery. Robotic surgery is a reality today in many hospitals, which makes essential bioethical reflection on the relationship between health professionals, automata and patients. A utilização de robôs em procedimentos cirúrgicos tem sido cada vez mais frequente na atualidade, o que permite a emergência de inúmeras questões bioéticas nesse âmbito. Apresentar revisão sobre os aspectos éticos dos usos de robôs em cirurgia. Realizou-se revisão nas bases de dados Pubmed, SciELO e Lilacs cruzando-se os descritores "bioética", "cirurgia", "ética", "laparoscopia" e "robótica". Do total de citações obtidas, selecionou-se 17 artigos, os quais foram utilizados para a elaboração do artigo. Ele contém breve apresentação sobre a robótica, sua inserção na saúde e os aspectos bioéticos da utilização dos robôs em procedimentos cirúrgicos. A cirurgia robótica é uma realidade, hoje, em muitas unidades hospitalares, o que torna essencial a reflexão bioética sobre as relações entre profissionais da saúde, autômatos e pacientes.

  9. Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience.

    Science.gov (United States)

    Akhtar, Raja Parvez; Abid, Abdul Rehman; Zafar, Hasnain; Gardezi, Syed Javed Raza; Waheed, Abdul; Khan, Jawad Sajid

    2007-10-01

    To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. It was a cohort study. The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of non-cardiac surgical operation with minimal risk.

  10. Bilateral corneal denting after surgery under general anesthesia: A case report

    Directory of Open Access Journals (Sweden)

    Satsuki Obata

    2018-06-01

    Full Text Available Purpose: To report a case of temporary bilateral corneal denting in a patient who underwent cardiovascular surgery under general anesthesia. Observations: A 71-year-old male with no history of ophthalmological disease experienced bilateral corneal denting immediately after undergoing surgery for aneurysm of the thoracic aorta under general anesthesia. Anesthesia was induced with propofol and maintained with rocuronium bromide and remifentanil hydrochloride. The initial examination revealed significant denting on the surface of both the corneas and ocular hypotension. Visual evaluation could not be performed due to the patient's low level of consciousness resulting from delayed emergence from anesthesia. After applying tropicamide and phenylephrine ophthalmic solution for fundus examination, the ocular morphology improved. Ocular pressure was normal on the day after surgery, and creasing on the surface of the corneas had disappeared. Conclusions: and Importance: We experienced a patient with bilateral corneal denting following a cardiovascular surgery under general anesthesia. The dents could be attributed to augmentation of ocular hypotension using several types of anesthesia at relatively high doses. Keywords: General anesthesia, Cornea denting, Complication, Cardiovascular surgery

  11. Clinical effects of blood transfusion during the immediate postoperative period in cardiac surgery patients

    Directory of Open Access Journals (Sweden)

    Vasilis Hatzitolias

    2015-09-01

    Full Text Available Introduction: Blood transfusion is common in patients undergoing cardiac surgery. Aim: Our goal was to investigate the association between blood transfusions in the early postoperative period and complications during Cardiac Intensive Care Unit (CICU stay. Methods: Retrospectively analysis in 874 patients who underwent isolated coronary artery bypass grafting, valve surgery or combined procedures. Patients were allocated to two groups according to the presence (Group A or absence (Group B of blood transfusion during extracorporeal circulation, surgery and CICU stay. Two hundred thirty four patients with preexisting hepatic or blood diseases, atrial fibrillation, emergent surgery or those received autologous blood transfusions were excluded prior to the study. Morbidity was defined as prolonged postoperative mechanical ventilation, mechanical ventilation>7hours, reintubation, use of non-invasive ventilation, postoperative atrial fibrillation and length of hospital stay. Statistical analysis was carried out using Chi-square, Student’s t-test, Relative Risk (RR and logistic regression with statistical significance set at p7 hours (p 7 hours (p<0.01. Conclusions: Blood transfusions seem to associate with certain complications in cardiac surgery patients.

  12. Aortoiliac reconstructive surgery based upon the results of duplex scanning

    NARCIS (Netherlands)

    van der Zaag, E. S.; Legemate, D. A.; Nguyen, T.; Balm, R.; Jacobs, M. J.

    1998-01-01

    OBJECTIVE: To evaluate whether duplex scanning can replace angiography in patients operated for aortoiliac obstructive disease. DESIGN: Retrospective. MATERIALS AND METHODS: Between January 1995 and October 1996, 44 patients underwent vascular surgery of the aortoiliac tract. The study population

  13. Outcome after translabyrinthine surgery for vestibular schwannomas

    DEFF Research Database (Denmark)

    Springborg, Jacob Bertram; Fugleholm, Kåre; Poulsgaard, Lars

    2012-01-01

    The objective of this article is to study the outcome after translabyrinthine surgery for vestibular schwannomas, with special focus on the facial nerve function. The study design is a case series from a national centralized database and it is set in two University Hospitals in Denmark....... Participants were 1244 patients who underwent translabyrinthine surgery during a period of 33 years from 1976 to 2009. Main outcome measures were tumor removal, intraoperative facial nerve preservation, complications, and postoperative facial nerve function. In 84% patients, the tumor was totally resected...... and in ~85% the nerve was intact during surgery. During 33 years, 12 patients died from complications to surgery and ~14% had cerebrospinal fluid leakage. Before surgery, 74 patients had facial paresis and 46% of these improved after surgery. In patients with normal facial function, overall ~70% had a good...

  14. Type A aortic dissection in Marfan syndrome: extent of initial surgery determines long-term outcome.

    Science.gov (United States)

    Rylski, Bartosz; Bavaria, Joseph E; Beyersdorf, Friedhelm; Branchetti, Emanuela; Desai, Nimesh D; Milewski, Rita K; Szeto, Wilson Y; Vallabhajosyula, Prashanth; Siepe, Matthias; Kari, Fabian A

    2014-04-01

    Data on outcomes after Stanford type A aortic dissection in patients with Marfan syndrome are limited. We investigated the primary surgery and long-term results in patients with Marfan syndrome who suffered aortic dissection. Among 1324 consecutive patients with aortic dissection type A, 74 with Marfan syndrome (58% men; median age, 37 years [first and third quartiles, 29 and 48 years]) underwent surgical repair (85% acute dissections; 68% DeBakey I; 55% composite valved graft, 30% supracoronary ascending replacement, 15% valve-sparing aortic root replacement; 12% total arch replacement; 3% in-hospital mortality) at 2 tertiary centers in the United States and Europe over the past 25 years. The rate of aortic reintervention with resternotomy was 24% (18 of 74) and of descending aorta (thoracic+abdominal) intervention was 30% (22 of 74) at a median follow-up of 8.4 years (first and third quartiles, 2.2 and 12.7 years). Freedom from need for aortic root reoperation in patients who underwent primarily a composite valved graft or valve-sparing aortic root replacement procedure was 95±3%, 88±5%, and 79±5% and in patients who underwent supracoronary ascending replacement was 83±9%, 60±13%, 20±16% at 5, 10, and 20 years. Secondary aortic arch surgery was necessary only in patients with initial hemi-arch replacement. Emergency surgery for type A dissection in patients with Marfan syndrome is associated with low in-hospital mortality. Failure to extend the primary surgery to aortic root or arch repair leads to a highly complex clinical course. Aortic root replacement or repair is highly recommended because supracoronary ascending replacement is associated with a high need (>40%) for root reintervention.

  15. Tennis elbow surgery

    Science.gov (United States)

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  17. Mohs micrographic surgery

    Science.gov (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  18. Single-port access laparoscopic surgery for rectal cancer: initial experience with 10 cases

    DEFF Research Database (Denmark)

    Bulut, Orhan; Nielsen, Claus B; Jespersen, Niels

    2011-01-01

    Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined.......Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined....

  19. Surgery for atrial fibrillation.

    Science.gov (United States)

    Viganò, M; Graffigna, A; Ressia, L; Minzioni, G; Pagani, F; Aiello, M; Gazzoli, F

    1996-01-01

    The mechanisms of atrial fibrillation arc multiple reentry circuits spinning around the atrial surface, and these baffle any attempt to direct surgical interruption. The purpose of this article is to report the surgical experience in the treatment of isolated and concomitant atrial fibrillation at the Cardiac Surgical Institute of the University of Pavia. In cases of atrial fibrillation secondary to mitral/valve disease, surgical isolation of the left atrium at the time of mitral valve surgery can prevent atrial fibrillation from involving the right atrium, which can exert its diastolic pump function on the right ventricle. Left atrial isolation was performed on 205 patients at the time of mitral valve surgery. Atrial partitioning ("maze operation") creates straight and blind atrial alleys so that non-recentry circuits can take place. Five patients underwent this procedure. In eight-cases of atrial fibrillation secondary to atrial septal defect, the adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation underwent surgical isolation of the right atrium associated which surgical correction of the defect, in order to let sinus rhythm govern the left atrium and the ventricles. "Lone" atrial fibrillation occurs in hearts with no detectable organic disease. Bi-atrial isolation with creation of an atrial septal internodal "corridor" was performed on 14 patients. In cases of atrial fibrillation secondary to mitral valve disease, left atrial isolation was performed on 205 patients at the time of mitral valve surgery with an overall sinus rhythm recovery of 44%. In the same period, sinus rhythm was recovered and persisted in only 19% of 252 patients who underwent mitral valve replacement along (P < 0.001). Sinus rhythm was less likely to recover in patients with right atriomegaly requiring tricuspid valve annuloplasty: 59% vs 84% (P < 0.001). Restoration of the right atrial function raised the cardiac index from 2.25 +/- 0.55 1/min per m2

  20. The Bt-DUX: Development of a subjective measure of health-related quality of life in patients who underwent surgery for lower extremity malignant bone tumor

    NARCIS (Netherlands)

    W.P. Bekkering (Peter); T.P.M. Vliet Vlieland (Theodora); H.M. Koopman (Hendrik); G.R. Schaap (Gerard); H.W.B. Schreuder; A. Beishuizen (Auke); W.J.E. Tissing (Wim); P.M. Hoogerbrugge (Peter); J.K. Anninga (Jacob); A.H.M. Taminiau (Antonie)

    2009-01-01

    textabstractBackground. To examine the practical applicability, internal consistency, and validity of the Bt-DUX, a disease-specific Health Related Quality of Life (HRQoL) instrument. The Bt-Dux was developed to examine patients' individual values of their life after a malignant bone tumor of the

  1. Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

    Directory of Open Access Journals (Sweden)

    Osman Karakus

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS system Class 4 (50%, Cormack-Lehane classification (CLS Grade 4 (95.7%, previous knowledge of difficult airway (86.2%, restricted neck movements (cervical ROM (75.8%, short thyromental distance (TMD (81.6%, vocal cord mass (49.5% as indicated in parentheses (p < 0.0001. MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

  2. [Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery].

    Science.gov (United States)

    Karakus, Osman; Kaya, Cengiz; Ustun, Faik Emre; Koksal, Ersin; Ustun, Yasemin Burcu

    2015-01-01

    Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack-Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p<0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  3. Endovascular control of haemorrhagic urological emergencies: an observational study

    Directory of Open Access Journals (Sweden)

    Thorpe Peter

    2006-09-01

    Full Text Available Abstract Background Transarterial embolisation (TAE is an effective method in control of haemorrhage irrespective of the nature of urological emergency. As the technique and technology have evolved, it is now possible to perform highly selective embolisation. The aim of this study was to critically appraise feasibility and efficacy of therapeutic TAE in control of haemorrhagic urological emergencies using selective and non-selective embolisation. Specifically, we aimed to assess the impact of timing of embolisation on the requirement of blood transfusion and long-term morphological and functional follow-up of embolised organs. Methods This is a single institutional observational study carried out between March 1992 and March 2006. Records of all patients who underwent selective and non-selective angioembolisation to control bleeding in urological emergencies were reviewed. Data on success rate, periprocedural complications, timing of embolisation, requirement of blood transfusion and the long-term morphological and functional outcomes of embolised organs was recorded. Results Fourteen patients underwent endovascular control of bleeding as a result of trauma, iatrogenic injury and spontaneous perinephric haemorrhage during a period of 14 years. All these patients would have required emergency open surgery without the option of embolisation procedure. The mean time between the first presentation and embolisation was 22 hours (range 30 minutes to 60 hours. Mean pre-embolisation transfusion requirement was 6.8 units (range 0–22 units. None of the patients with successful embolisation required post-procedural blood transfusion. Permanent haemostasis was achieved in all but one patient, who required emergency nephrectomy. There were no serious procedure related post-embolisation complications. Conclusion Endovascular control using transarterial angioembolisation is an effective method for managing haematuria or haemorrhage in urological emergencies

  4. Hypoglossal Nerve Palsy After Cervical Spine Surgery

    OpenAIRE

    Ames, Christopher P.; Clark, Aaron J.; Kanter, Adam S.; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel

    2017-01-01

    Study Design: Multi-institutional retrospective study. Objective: The goal of the current study is to quantify the incidence of 2 extremely rare complications of cervical spine surgery; hypoglossal and glossopharyngeal nerve palsies. Methods: A total of 8887 patients who underwent cervical spine surgery from 2005 to 2011 were included in the study from 21 institutions. Results: No glossopharyngeal nerve injuries were reported. One hypoglossal nerve injury was reported after a C3-7 laminectomy...

  5. Diabetic Emergencies

    Science.gov (United States)

    ... Campaigns Share this! EmergencyCareForYou » Emergency 101 » Diabetic Emergencies Diabetic Emergencies It is estimated that more than 20 ... they have it. The best way to prevent diabetic emergencies is to effectively manage the disease through ...

  6. Emergency presurgical visit

    Directory of Open Access Journals (Sweden)

    Alfredo Castro Díaz

    2009-07-01

    Full Text Available The objective has been to create a Protocol of Structured Presurgical Visit applicable to the patients who are undergoing an emergency surgery, to provide the user and his family all the necessary cares on the basis of those nursing diagnosis that prevail in all the cases of surgical emergency interventions. The used method has been an analysis of the emergency surgical interventions more prevalent from February 2007 until October 2008 in our area (a regional hospital, and statistic of those nursing diagnosis that more frequently appeared in these interventions, the previous moment to the intervention and in addition common to all of them. The results were the following ones: the more frequent emergency operations were: Caesarean, ginecological curettage, laparotomy, help in risk childbirth, orthopaedic surgery and appendectomy. The more frequent nursing diagnosis in all the emergency operations at the previous moment of the intervention were: risk of falls, pain, anxiety, deficit of knowledge, risk of infection, movement stress syndrome, risk of hemorrhage, cutaneous integrity deterioration. The conclusion is that users present at the previous moment to an emergency operation several problems, which force to the emergency surgical ward nurse to the introduction of the nursing methodology, in order to identify the problems, to mark results and to indicate the interventions to achieve those results, besides in a humanitarian way and with quality. This can be obtained by performing a Structured Emergency Presurgical Visit.

  7. Emergency War Surgery: Third United States Revision

    Science.gov (United States)

    2004-01-01

    hospitals in the rear. Though one can hope that major strides in these and other areas of trauma resuscitation will be reflected in a future edition, our...more fervent hope is for mankind’s dream of peace and the exercise of his better Angels, … whereby this Handbook becomes altogether unnecessary. Dave... Ostomy Patients: Vent collection bags to avoid excess gas dislodging the bag from the stoma wafer. Use a straight pin to put two holes in the bag

  8. Maltomas and emergency surgery in children

    Directory of Open Access Journals (Sweden)

    Baeza Herrera Carlos

    2014-07-01

    Full Text Available The MALT tumor or maltoma, is a lymphoma type not yet well defined because it seems to be from the lymphatic tissue, but it is not included in that variety. It is more common in adults, the most frequent location is in the stomach. In children this tumor located in the small intestine is rare. We report our surgical experience in three patients who had a MALT tumor located one in the mucosa of the ileum and two in the serosa and mesentery of the small in- testine. Each one had a complication: intussusceptions, bleeding, bowel obstruction. They had to be operated urgently. All three patients are alive, two under surveillance and one under chemotherapy.

  9. Attempt of peripheral nerve reconstruction during lung cancer surgery.

    Science.gov (United States)

    Li, Hanyue; Hu, Yingjie; Huang, Jia; Yang, Yunhai; Xing, Kaichen; Luo, Qingquan

    2018-05-01

    Vagus nerve and recurrent laryngeal nerve (RLN) injury are not rare complications of lung cancer surgery and can cause lethal consequences. Until now, no optimal method other than paying greater attention during surgery has been available. Four patients underwent lung surgery that involved RLN or vagus nerve injury. The left RLN or vagus nerve was cut off and then reconstructed immediately during surgery. Two patients underwent direct anastomosis, while the remaining two underwent phrenic nerve replacing tension-relieving anastomosis. All patients were able to speak immediately after recovery. No or minimal glottal gap was observed during laryngoscopy conducted on the second day after surgery. Most patients achieved full recovery of voice quality. Immediate reconstruction of RLN is technically feasible and can be carried out with satisfying short-term and long-term outcomes. © 2018 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  10. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were...... in beauty than women (P = 0.030). Sixty-four percent replied that their attractiveness had been increased after OS. Eighty-six percent were happy with the results and 89% would recommend the surgery to others in need. No significant differences in esthetic results and satisfaction were seen with regard...

  11. Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Reza Arefizadeh

    2017-05-01

    CONCLUSIONS: Regarding QOL and psychological status, there were no differences in the CR outcome between those who underwent off-pump bypass surgery and those who underwent on-pump surgery; nevertheless, the off-pump technique was superior to the on-pump method on METs improvement following CR.

  12. Surgical outcome and clinical profile of emergency versus elective cases of colorectal cancer in College of Medical Sciences, Nepal

    Directory of Open Access Journals (Sweden)

    Sujit Kumar

    2014-01-01

    Full Text Available Background: Patients who undergo emergency colorectal cancer surgery has poor outcome compared to elective surgery, both in terms of morbidity and mortality. Approximately 15 to 30% of colorectal cancers present as an emergency, most often as obstruction or perforation. Objective: To compare surgical outcome and clinical profiles of emergency and elective cases for colorectal cancer. Methods: Retrospective analysis of 34 cases who underwent surgery for colorectal cancer between December 2011 to January 2013was carried out and their surgical outcomes, clinical presentation, demographic profile were analyzed. Results: The total numbers of patients included in this study were 34. Out of which 52.94 %( n=18 were emergency cases and 47.05 %( n=16 were elective. Male female ratio was 3:1 in emergency cases and 2.6:1 in elective cases. Per rectal bleeding (56% and altered bowel habit (31.25% was predominant clinical presentation in elective cases whereas intestinal obstruction (55.55% and peritonitis (22.22% were predominant clinical presentation in emergency cases. In emergency cases most of the tumors were located in left side (77.77% and in elective cases rectum was common site (37.5%. Left hemicolectomy was the commonest surgery performed (72.22% in emergency set up. In elective cases, right hemicolectomy, left hemicolectomy, APR and LAR was done in 31.25%, 31.25%, 25% and 25% cases respectively. In the emergency group 11.11% (n=2 developed enterocutaneous fistula and early mortality within 30 days was observed in 5% (n=1 of emergency cases only. Conclusion: In emergency conditions, colorectal cancer presented with intestinal obstruction where as elective cases presented with per rectal bleeding and altered bowel habits. Compared with the elective patients, the emergency patients had higher rate of morbidity and mortality. Because of higher incidence of colorectal cancer in our institution, in all emergency cases who presents with features of

  13. Intestinal Surgery.

    Science.gov (United States)

    Desrochers, André; Anderson, David E

    2016-11-01

    A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus. Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Elective bowel surgery with or without prophylactic nasogastric ...

    African Journals Online (AJOL)

    Methodology: 100 patients who underwent elective bowel surgery were randomized into two groups: Study group (50): Nasogastric tube was removed immediately after operation or in the recovery room. Control group (50): Underwent nasogastric tube removal postoperatively after the patient passed flatus and audible ...

  15. Emergency CT in blunt abdominal trauma of multiple injury patients

    International Nuclear Information System (INIS)

    Kinnunen, J.; Kivioja, A.; Poussa, K.; Laasonen, E.M.

    1994-01-01

    Multiple injury patients with blunt abdominal trauma (n = 110) were examined by abdominal CT. An i.v., but not peroral, contrast medium was used, thereby eliminating the delay caused by administering peroral contrast medium and any subsequent delay in making the diagnoses and beginning operative treatment. Eighteen patients underwent emergency laparotomy after the initial CT examination. The preoperative CT findings were compared to the laparotomy findings. CT revealed all but one of the severe parenchymal organ lesions requiring surgery. The one liver laceration that went undetected had caused hemoperitoneum, which was diagnosed by CT. The bowel and mesenteric lesions presented as intra-abdominal blood, and the hemoperitoneum was discovered in every patient with these lesions. Fourteen patients also initially had positive abdominal CT findings; 10 of them underwent an additional abdominal CT within 3 days, but the repeat studies did not reveal any lesions in need of surgery. Omission of the oral contrast medium did not jeopardize making the essential diagnoses, but it did save time. (orig.)

  16. Emergency Communication

    Science.gov (United States)

    : Environmental Documents, Reports LANL Home Calendar Search Contacts Resources » Emergency Communication Emergency Communication Stay informed of emergencies, weather delays, closures, other alerts. Find links to

  17. Pharyngeal airway changes following mandibular setback surgery

    Directory of Open Access Journals (Sweden)

    Babu Ramesh

    2005-01-01

    Full Text Available Treatment of dentofacial deformities with jaw osteotomies has an effect on airway anatomy and therefore mandibular setback surgery has the potential to diminish airway size. The purpose of this study was to evaluate the effect of mandibular setback surgery on airway size. 8 consecutive patients were examined prospectively. All patients underwent mandibular setback surgery. Cephalometric analysis was performed preoperatively and 3 months post operatively with particular attention to pharyngeal airway changes. Pharyngeal airway size decreased considerably in all, patients thus predisposing to development of obstructive sleep apnea. Therefore, large anteroposterior discrepancies should be corrected by combined maxillary and mandibular osteotomies.

  18. Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities.

    Science.gov (United States)

    Gupta, Varun; Parikh, Rikesh; Nguyen, Lyly; Afshari, Ashkan; Shack, R Bruce; Grotting, James C; Higdon, K Kye

    2017-02-01

    There has been a dramatic rise in office-based surgery. However, due to wide variations in regulatory standards, the safety of office-based aesthetic surgery has been questioned. This study compares complication rates of cosmetic surgery performed at office-based surgical suites (OBSS) to ambulatory surgery centers (ASCs) and hospitals. A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 were identified from the CosmetAssure database (Birmingham, AL). Patients were grouped by type of accredited facility where the surgery was performed: OBSS, ASC, or hospital. The primary outcome was the incidence of major complication(s) requiring emergency room visit, hospital admission, or reoperation within 30 days postoperatively. Potential risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of procedure, and combined procedures were reviewed. Of the 129,007 patients (183,914 procedures) in the dataset, the majority underwent the procedure at ASCs (57.4%), followed by hospitals (26.7%) and OBSS (15.9%). Patients operated in OBSS were less likely to undergo combined procedures (30.3%) compared to ASCs (31.8%) and hospitals (35.3%, P procedures. Plastic surgeons should continue to triage their patients carefully based on other significant comorbidities that were not measured in this present study. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  19. GENERAL SURGERY

    African Journals Online (AJOL)

    surgery. Since the first laparoscopic treatment of hydatid disease was described in 1992,14 there has been a steady growth in reports of the laparoscopic treatment of hydatid cysts of liver. Although early reported laparoscopic treatment of liver hydatid disease was confined to simple drainage, more advanced laparoscopic ...

  20. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  1. TRAUMA SURGERY

    African Journals Online (AJOL)

    meet the criteria for damage control surgery, and ligation of the AVC is a .... There were two vertebral body fractures, one penetrating brain injury from a gunshot wound to the head, one ... two hand fractures, three haemothoraces, one pelvic fracture, .... One patient with an intimal flap injury to his left common iliac artery ...

  2. GENERAL SURGERY

    African Journals Online (AJOL)

    Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

  3. Rodding Surgery

    Science.gov (United States)

    ... Physical activity prior to surgery,  Length of the operation; anesthesia issues,  Reason for the choice of rod,  Time in the hospital,  Length of recovery time at home,  Pain management including control of muscle spasms,  The rehabilitation plan. ...

  4. Aortic root surgery in Marfan syndrome.

    Science.gov (United States)

    Sheick-Yousif, Basheer; Sheinfield, Ami; Tager, Salis; Ghosh, Probal; Priesman, Sergey; Smolinsky, Aram K; Raanani, Ehud

    2008-03-01

    As the shortcomings of the Bentall operation and its variants in the Marfan syndrome have become apparent, the recent cusp-sparing techniques (remodeling or reimplantation) bear promise of better mid-term and long-term outcomes. To examine the results of aortic root surgery in patients with Marfan syndrome. During the period March 1994 to September 2007, 220 patients underwent aortic valve-sparing surgery; 20 were Marfan patients (group 1) who were compared with another 20 Marfan patients undergoing composite aortic root replacement (group 2). Fourteen patients had aortic dissection and 26 had thoracic aortic aneurysm. There were 31 males and 9 females with a mean age of 37.9 +/- 13.8 years. In group 1, reimplantation was used in 13 patients, remodeling in 4, and aortic valve repair with sinotubular junction replacement in 3. In group 2, a mechanical valve conduit was used. Mean logistic Euroscore was 12.27 +/- 14.6% for the whole group, five of whom were emergent cases Group 2 had more previous cardiac procedures compared to group 1 (9 vs. 2, P = 0.03) and shorter cross-clamp time (122 +/- 27.1 vs. 153.9 +/- 23.7 minutes, P = 0.0004). Overall mortality was 10%. Early mortality was 10% in group 2 and 5% in group 1 (NS). Mean follow-up time was 25 months for group 2 and 53 months for group 1. Three patients were reoperated; all had undergone the remodeling. Five year freedom from reoperation and death was 86% and 90% in group 2 and 70% and 95% in group 1 (P = 0.6, P = 0.6), respectively. Late survival of patients with Marfan syndrome was similar in both groups. Root reconstruction tends towards a higher incidence of late reoperations if the remodeling technique is used. We now prefer to use the reimplantation technique.

  5. Achalasia: Dilation, Injection or Surgery?

    OpenAIRE

    Peracchia, Alberto; Bonavina, Luigi

    2000-01-01

    Achalasia results from irreversible alterations of the esophageal myenteric plexus. The target of treatment in this setting is to reduce lower esophageal sphincter resistance to passage of the bolus. Definitive treatment of the disease requires pneumatic dilation or Heller myotomy. Although no controlled studies comparing modern endoscopic and surgical techniques are available, laparoscopic surgery is emerging as the initial intervention of choice.

  6. Complication rates of ostomy surgery are high and vary significantly between hospitals.

    Science.gov (United States)

    Sheetz, Kyle H; Waits, Seth A; Krell, Robert W; Morris, Arden M; Englesbe, Michael J; Mullard, Andrew; Campbell, Darrell A; Hendren, Samantha

    2014-05-01

    Ostomy surgery is common and has traditionally been associated with high rates of morbidity and mortality, suggesting an important target for quality improvement. The purpose of this work was to evaluate the variation in outcomes after ostomy creation surgery within Michigan to identify targets for quality improvement. This was a retrospective cohort study. The study took place within the 34-hospital Michigan Surgical Quality Collaborative. Patients included were those undergoing ostomy creation surgery between 2006 and 2011. We evaluated hospital morbidity and mortality rates after risk adjustment (age, comorbidities, emergency vs elective, and procedure type). A total of 4250 patients underwent ostomy creation surgery; 3866 procedures (91.0%) were open and 384 (9.0%) were laparoscopic. Unadjusted morbidity and mortality rates were 43.9% and 10.7%. Unadjusted morbidity rates for specific procedures ranged from 32.7% for ostomy-creation-only procedures to 47.8% for Hartmann procedures. Risk-adjusted morbidity rates varied significantly between hospitals, ranging from 31.2% (95% CI, 18.4-43.9) to 60.8% (95% CI, 48.9-72.6). There were 5 statistically significant high-outlier hospitals and 3 statistically significant low-outlier hospitals for risk-adjusted morbidity. The pattern of complication types was similar between high- and low-outlier hospitals. Case volume, operative duration, and use of laparoscopic surgery did not explain the variation in morbidity rates across hospitals. This work was limited by its retrospective study design, by unmeasured variation in case severity, and by our inability to differentiate between colostomies and ileostomies because of the use of Current Procedural Terminology codes. Morbidity and mortality rates for modern ostomy surgery are high. Although this type of surgery has received little attention in healthcare policy, these data reveal that it is both common and uncommonly morbid. Variation in hospital performance provides an

  7. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  8. Impact of Polypharmacy on Adherence to Evidence-Based Medication in Patients who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Mohammed, Shaban; Arabi, Abdulrahaman; El-Menyar, Ayman; Abdulkarim, Sabir; AlJundi, Amer; Alqahtani, Awad; Arafa, Salah; Al Suwaidi, Jassim

    2016-01-01

    The primary objective of this study was to evaluate the impact of polypharmacy on primary and secondary adherence to evidence-based medication (EBM) and to measure factors associated with non-adherence among patients who underwent percutaneous coronary intervention (PCI). We conducted a retrospective analysis for patients who underwent PCI at a tertiary cardiac care hospital in Qatar. Patients who had polypharmacy (defined as ≥6 medications) were compared with those who had no polypharmacy at hospital discharge in terms of primary and secondary adherence to dual antiplatelet therapy (DAPT), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEIs) and statins. A total of 557 patients (mean age: 53±10 years; 85%; males) who underwent PCI were included. The majority of patients (84.6%) received ≥6 medications (polypharmacy group) while only 15.4% patients received ≥5 medications (nonpolypharmacy group). The two groups were comparable in term of gender, nationality, socioeconomic status and medical insurance. The non-polypharmacy patients had significantly higher adherence to first refill of DAPT compared with patients in the polypharmacy group (100 vs. 76.9%; p=0.001). Similarly, the non-polypharmacy patients were significantly more adherent to secondary preventive medications (BB, ACEI and statins) than the polypharmacy group. In patients who underwent PCI, polypharmacy at discharge could play a negative role in the adherence to the first refill of EBM. Further studies should investigate other parameters that contribute to long term non-adherence.

  9. Pseudo tumors of the lung after lung volume reduction surgery.

    Science.gov (United States)

    Oey, Inger F; Jeyapalan, Kanagaratnam; Entwisle, James J; Waller, David A

    2004-03-01

    We describe 2 patients who underwent lung volume reduction surgery, who postoperatively had computed tomographic scans that showed symptomatic mass lesions suggestive of malignancy and an inhaled foreign body. Investigations excluded these conditions with the remaining likely diagnosis of pseudotumor secondary to buttressing material. These potential sequelae of lung volume reduction surgery should be recognized in follow-up investigations.

  10. Experiencing your own orthognathic surgery: A personal case report

    NARCIS (Netherlands)

    Mensink, Gertjan; Gooris, Peter; Mulder, Florine; Gooris-Kuipers, Christel; van Merkesteyn, Richard

    2015-01-01

    There has been much research on minimizing the side effects of orthognathic surgery. However, there are very few doctors and researchers who themselves have undergone this surgery. This case report describes the findings of a maxillofacial surgeon who underwent combined orthodontic and orthognathic

  11. Experiencing your own orthognathic surgery: a personal case report

    NARCIS (Netherlands)

    Mensink, G.; Gooris, P.; Mulder, F.; Gooris-Kuipers, C.; van Merkestyn, R.

    2015-01-01

    There has been much research on minimizing the side effects of orthognathic surgery. However, there are very few doctors and researchers who themselves have undergone this surgery. This case report describes the findings of a maxillofacial surgeon who underwent combined orthodontic and orthognathic

  12. Unmasking sarcoidosis following surgery for Cushing disease.

    Science.gov (United States)

    Diernaes, Jon E F; Bygum, Anette; Poulsen, Per L

    2016-01-01

    We present a patient with Cushing disease apparently suppressing sarcoidosis, which was unmasked following surgical resection of a pituitary adrenocorticotropin (ACTH)-producing microadenoma. Case report and a short review of the literature published in this area. A 46-year-old Caucasian woman presented with symptoms of hypercortisolism such as progressive weight gain, Cushingoid appearance, proximal myopathy, easy bruising, and amenorrhea. Blood testing including inferior petrosal sinus sampling uncovered an ACTH-producing microadenoma in the right aspect of the anterior pituitary gland for which the patient underwent transphenoidal resection. Maintenance corticosteroid therapy was implemented, and the signs and symptoms of Cushing disease began to resolve. Three months after surgery, multiple erythematous painful nodules developed on the patient's arms. Erythema nodosum (EN) was diagnosed clinically and a suspicion of underlying sarcoidosis was substantiated by lung imaging and elevated plasma interleukin (IL)-2 receptor. One month later, the lesions spontaneously resolved without therapy other than maintenance glucocorticoid replacement. Physicians should be aware that patients undergoing successful treatment of Cushing syndrome may have a flare-up or emergence of a corticosteroid-responsive disease.

  13. Language recovery after epilepsy surgery of the Broca's area

    Directory of Open Access Journals (Sweden)

    Lilit Mnatsakanyan

    Full Text Available Epilepsy surgery is indicated in select patients with drug-resistant focal epilepsy. Seizure freedom or significant reduction of seizure burden without risking new neurological deficits is the expected goal of epilepsy surgery. Typically, when the seizure onset zone overlaps with eloquent cortex, patients are excluded from surgery.We present a patient with drug-resistant frontal lobe epilepsy who underwent successful surgery with resection of Broca's area, primarily involving the pars triangularis (BA 45. We report transient expressive aphasia followed by recovery of speech. This case provides new insights into adult neuroplasticity of the language network. Keywords: Epilepsy surgery, Eloquent cortex, Language and epilepsy, Refractory epilepsy, Electrocorticography

  14. Added Healthcare Charges Conferred by Smoking in Outpatient Plastic Surgery.

    Science.gov (United States)

    Sieffert, Michelle R; Johnson, R Michael; Fox, Justin P

    2018-01-31

    A history of smoking confers additional risk of complications following plastic surgical procedures, which may require hospital-based care to address. To determine if patients with a smoking history experience higher rates of complications leading to higher hospital-based care utilization, and therefore greater healthcare charges, after common outpatient plastic surgeries. Using ambulatory surgery data from California, Florida, Nebraska, and New York, we identified adult patients who underwent common facial, breast, or abdominal contouring procedures from January 2009 to November 2013. Our primary outcomes were hospital-based, acute care (hospital admissions and emergency department visits), serious adverse events, and cumulative healthcare charges within 30 days of discharge. Multivariable regression models were used to compare outcomes between patients with and without a smoking history. The final sample included 214,761 patients, of which 10,426 (4.9%) had a smoking history. Compared to patients without, those with a smoking history were more likely to have a hospital-based, acute care encounter (3.4% vs 7.1%; AOR = 1.36 [1.25-1.48]) or serious adverse event (0.9% vs 2.2%; AOR = 1.38 [1.18-1.60]) within 30 days. On average, these events added $1826 per patient with a smoking history. These findings were consistent when stratified by specific procedure and controlled for patient factors. Patients undergoing common outpatient plastic surgery procedures who have a history of smoking are at risk for more frequent complications, and incur higher healthcare charges than patients who are nonsmokers. © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  15. Childhood Emergencies

    Science.gov (United States)

    ... SUBSCRIBE Emergency 101 Share this! Home » Emergency 101 Childhood Emergencies Keeping children healthy and safe is every ... and tools to prevent, recognize and address a childhood emergency is the first step in keeping your ...

  16. Emergency contraception

    Science.gov (United States)

    Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B; Family planning - emergency contraception ... IUD placed inside the uterus CHOICES FOR EMERGENCY CONTRACEPTION Two emergency contraceptive pills may be bought without a prescription. ...

  17. Noncardiac Surgery in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Jørgensen, Mads Emil; Martinsson, Andreas

    2014-01-01

    (MACE) and all-cause mortality were investigated in a contemporary Danish cohort. HYPOTHESIS: AS is not an independent risk factor for adverse outcomes in noncardiac surgery. METHODS: All patients with and without diagnosed AS who underwent noncardiac surgery in 2005 to 2011 were identified through......BACKGROUND: Past research has identified aortic stenosis (AS) as a major risk factor for adverse outcomes in noncardiac surgery; however, more contemporary studies have questioned the grave prognosis. To further our understanding of this, the risks of a 30-day major adverse cardiovascular event...... nationwide administrative registers. AS patients (n = 2823; mean age, 75.5 years, 53% female) were matched with patients without AS (n = 2823) on propensity score for AS and surgery type. RESULTS: In elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death...

  18. Implementation of an acute care emergency surgical service: a cost analysis from the surgeon's perspective.

    Science.gov (United States)

    Anantha, Ram Venkatesh; Parry, Neil; Vogt, Kelly; Jain, Vipan; Crawford, Silvie; Leslie, Ken

    2014-04-01

    Acute care surgical services provide comprehensive emergency general surgical care while potentially using health care resources more efficiently. We assessed the volume and distribution of emergency general surgery (EGS) procedures before and after the implementation of the Acute Care and Emergency Surgery Service (ACCESS) at a Canadian tertiary care hospital and its effect on surgeon billings. This single-centre retrospective case-control study compared adult patients who underwent EGS procedures between July and December 2009 (pre-ACCESS), to those who had surgery between July and December 2010 (post-ACCESS). Case distribution was compared between day (7 am to 3 pm), evening (3 pm to 11 pm) and night (11 pm to 7 am). Frequencies were compared using the χ(2) test. Pre-ACCESS, 366 EGS procedures were performed: 24% during the day, 55% in the evening and 21% at night. Post-ACCESS, 463 operations were performed: 55% during the day, 36% in the evening and 9% at night. Reductions in night-time and evening EGS were 57% and 36% respectively (p cost-modelling analysis, post-ACCESS surgeon billing for appendectomies, segmental colectomies, laparotomies and cholecystectomies all declined by $67 190, $125 215, $66 362, and $84 913, respectively (p Cost-modelling analysis demonstrates that these services have cost-savings potential for the health care system without reducing overall surgeon billing.

  19. General Surgery

    African Journals Online (AJOL)

    bbshehu

    Methods: We reviewed all case-notes, radiological records and histology reports of ... contamination, anastomotic technique, emergency ... identified at laparotomy for peritonitis or during post mortem; 3) Clinical features of a leak confirmed by.

  20. Metabolic Surgery

    DEFF Research Database (Denmark)

    Pareek, Manan; Schauer, Philip R; Kaplan, Lee M

    2018-01-01

    The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown...... the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity....... Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further...

  1. Primary Surgery or Interval Debulking for Advanced Epithelial Ovarian Cancer

    DEFF Research Database (Denmark)

    Markauskas, Algirdas; Mogensen, Ole; dePont Christensen, René

    2014-01-01

    OBJECTIVE: The aim of the present study was to investigate the surgical complexity, the postoperative morbidity, and the survival of the women after primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for advanced epithelial ovarian cancer....... MATERIALS AND METHODS: We consecutively included all patients who underwent debulking surgery at our institution between January 2007 and December 2012 for stages IIIc and IV of epithelial ovarian cancer. RESULTS: Of the 332 patients included, 165 (49.7%) underwent PDS, and 167 (50.3%) had NACT...

  2. Preparing for Surgery

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Preparing for Surgery Home For Patients Search FAQs Preparing for Surgery ... Surgery FAQ080, August 2011 PDF Format Preparing for Surgery Gynecologic Problems What is the difference between outpatient ...

  3. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  4. Corrective Jaw Surgery

    Science.gov (United States)

    ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  6. Facial Cosmetic Surgery

    Science.gov (United States)

    ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  7. Heart bypass surgery

    Science.gov (United States)

    Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

  8. Glaucoma Drainage Device Erosion Following Ptosis Surgery.

    Science.gov (United States)

    Bae, Steven S; Campbell, Robert J

    2017-09-01

    To highlight the potential risk of glaucoma drainage device erosion following ptosis surgery. Case report. A 71-year-old man underwent uncomplicated superotemporal Ahmed glaucoma valve implantation in the left eye in 2008. Approximately 8 years later, the patient underwent bilateral ptosis repair, which successfully raised the upper eyelid position. Three months postoperatively, the patient's glaucoma drainage implant tube eroded through the corneal graft tissue and overlying conjunctiva to become exposed. A graft revision surgery was successfully performed with no further complications. Caution and conservative lid elevation may be warranted when performing ptosis repair in patients with a glaucoma drainage implant, and patients with a glaucoma implant undergoing ptosis surgery should be followed closely for signs of tube erosion.

  9. The Disability Impact and Associated Cost per Disability in Women Who Underwent Surgical Revision of Transvaginal Mesh Kits for Prolapse Repair.

    Science.gov (United States)

    Javadian, Pouya; Shobeiri, S Abbas

    2017-09-13

    The aim of this study was to investigate disability impact in patients and cost to the families of patients who have had complications of transvaginal prolapse mesh kits and underwent surgical revision. Patients who developed complications of transvaginal mesh kits for prolapse and who had undergone vaginal prolapse mesh surgical revision/removal in 2009 to 2014 at a single institution were identified by Current Procedural Terminology codes. The group was invited to complete a phone survey pertaining to the initial vaginal mesh used for prolapse surgery utilizing Sheehan Disability Scale (scale 0-10) and Years of life Lived with Disability (YLDs) questionnaires. The data collected were used to estimate the disability and cost analysis. We used our data to estimate the economic and quality-of-life impact of vaginal mesh complications on patients in the United States RESULTS: Sixty-two patients (62/198 [31.2%]) were consented to participate and completed the questionnaires by phone. Extremely disabled patients were 18 (29%) of 62 of whole cases, and 5 (8%) of 62 reported that they had no disability after vaginal mesh surgery. The median for overall disability score after vaginal mesh procedure was 8 (which reflects marked disability on a scale of 0-10). The majority of patients missed a median of 12 months of their school or work because of their mesh complications. Thirty-seven (59.6%) of 62 did not improve after mesh removal. Twenty-one (33.9%) of 62 stated that their family income dropped because of productivity loss related to mesh complications. The mean time between vaginal mesh surgery and mesh removal procedure was 4.7 years. Sheehan Disability Scale scores are significantly correlated with YLDs outcomes. Patients' overall disability score showed a significant correlation with YLDs scores (P mesh for prolapse reduction complications had a sustained disability impact that continued despite mesh removal. Likewise, the complications were associated with

  10. Inadequate emergence after anesthesia: emergence delirium and hypoactive emergence in the Postanesthesia Care Unit.

    Science.gov (United States)

    Xará, Daniela; Silva, Acácio; Mendonça, Júlia; Abelha, Fernando

    2013-09-01

    To evaluate the frequency, determinants, and outcome of inadequate emergence after elective surgery in the Postanesthesia Care Unit (PACU). Prospective observational study. 12-bed PACU of a tertiary-care hospital in a major metropolitan area. 266 adult patients admitted to the PACU. To evaluate inadequate emergence, the Richmond Agitation and Sedation Scale (RASS) was administered to patients 10 minutes after their admission to the PACU. Demographic data, perioperative variables, and postoperative length of stay (LOS) in the PACU and the hospital were recorded. 40 (15%) patients showed symptoms of inadequate emergence: 17 patients (6.4%) screened positive for emergence delirium and 23 patients (8.6%) showed hypoactive emergence. Determinants of emergence delirium were longer duration of preoperative fasting (P = 0.001), higher visual analog scale (VAS) scores for pain (P = 0.002), and major surgical risk (P = 0.001); these patients had a higher frequency of postoperative delirium (P = 0.017) and had higher nausea VAS score 6 hours after surgery (P = 0.001). Determinants of hypoactive emergence were duration of surgery (P = 0.003), amount of crystalloids administered during surgery (P = 0.002), residual neuromuscular block (P < 0.001), high-risk surgery (P = 0.002), and lower core temperature on PACU admission (P = 0.028); these patients also had more frequent residual neuromuscular block (P < 0.001) postoperative delirium (P < 0.001), and more frequent adverse respiratory events (P = 0.02). Patients with hypoactive emergence had longer PACU and hospital LOS. Preventable determinants for emergence delirium were higher postoperative pain scores and longer fasting times. Hypoactive emergence was associated with longer postoperative PACU and hospital LOSs. © 2013 Elsevier Inc. All rights reserved.

  11. Low anastomotic leak rate after colorectal surgery: a single-centre study.

    Science.gov (United States)

    Jones, O M; John, S K P; Horseman, N; Lawrance, R J; Fozard, J B J

    2007-10-01

    Anastomotic leak after colorectal surgery is a serious event associated with significant morbidity and mortality. There is little consensus regarding 'acceptable' rates of leakage, however. This study describes the experience of anastomotic leakage after both elective and emergency colorectal surgery in a district general hospital. A prospectively collected database of all patients with a diagnosis of colorectal cancer in a single hospital formed the basis of the study. Leak was defined as breakdown of the anastomosis contributing to death or requiring reoperation or reintervention. A total of 949 patients underwent surgery with an anastomosis between 1996 and 2004, including 331 patients treated with anterior resection. Anastomotic leaks requiring reoperation occurred in eight patients (0.8%). Thirty-day and in-hospital mortality was 4%. A very low rate of anastomotic leakage after colorectal surgery is possible in a district general hospital setting. Given the impact of anastomotic leakage on function, tumour recurrence and long-term survival, it should be considered as a marker of surgical quality when evaluating surgical performance.

  12. Postoperative Calcium Management in Same-Day Discharge Thyroid and Parathyroid Surgery.

    Science.gov (United States)

    Nelson, Kurt L; Hinson, Andrew M; Lawson, Bradley R; Middleton, Derek; Bodenner, Donald L; Stack, Brendan C

    2016-05-01

    To describe a safe and effective postoperative prophylactic calcium regimen for same-day discharge thyroid and parathyroid surgery. Case series with chart review. Tertiary referral academic institution. In total, 162 adult patients who underwent total thyroidectomy, completion thyroidectomy, unilateral parathyroidectomy, parathyroidectomy with bilateral neck exploration, or revision parathyroidectomy were identified preoperatively to be candidates for same-day discharge. All patients in this study were successfully discharged the same day on our standard prophylactic calcium regimen. Less than 1% (1/162) of patients re-presented to the hospital within 30 days of surgery, and that patient was successfully discharged from the emergency department after negative workup for hypocalcemia. There was no significant difference between preoperative and postoperative calcium levels in the total/completion thyroidectomy groups (9.3 vs 9.2 mg/dL, respectively; P = .14). The average postoperative calcium level in the parathyroid group was well within normal limits (9.5 mg/dL), and the difference in postoperative calcium levels between revision and primary parathyroidectomy cases was not significantly different (P = .34). The reported calcium regimen demonstrates a safe, effective, and objective means of postoperative calcium management in outpatient thyroid and parathyroid surgery in appropriately selected patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  13. APACHE II SCORING SYSTEM AND ITS MODIFICATION FOR THE ASSESSMENT OF DISEASE SEVERITY IN CHILDREN WHO UNDERWENT POLYCHEMOTHERAPY

    Directory of Open Access Journals (Sweden)

    А. V. Sotnikov

    2014-01-01

    Full Text Available Short-term disease prognosis should be considered for the appropriate treatment policy based on the assessment of disease severity in patients with acute disease. The adequate assessment of disease severity and prognosis allows the indications for transferring patients to the resuscitation and intensive care department to be defined more precisely. Disease severity of patients who underwent polychemotherapy was assessed using APACHE II scoring system.

  14. Microdose flare-up vs. flexible-multidose GnRH antagonist protocols for poor responder patients who underwent ICSI.

    Science.gov (United States)

    Esinler, I

    2014-01-01

    To compare the performance of microdose flare-up (MF) and flexible-multidose gonadotropin-releasing hormone (GnRH) antagonist protocols in poor responder patients who underwent intracytoplasmic sperm injection (ICSI). One hundred and 12 consecutive patients (217 cycles) suspected to have poor ovarian response were enrolled. Group 1 (MF GnRH agonist group) constituted 64 patients (135 cycles) who underwent MF GnRH agonist protocol. Group 2 (flexible-multidose GnRH antagonist group) constituted 48 patients (82 cycles) who underwent flexible-multidose GnRH antagonist protocol. The duration of stimulation (d) (11.5 +/- 2.1 vs. 10.4 +/- 2.7, p or = seven blastomeres and < 10% fragmentation at day 3 (35.9% vs. 65.1%, p < 0.05) were significantly lower in Group 1 when compared to Group 2. The number of embryos transferred (2.2 +/- 1.3 vs. 2.4 +/- 0.9), the clinical pregnancy per embryo transfer (16.3% vs. 25.8%), and the implantation rate (8.6% vs. 12.2%) were comparable between groups. Although the flexible-multidose GnRH antagonist protocol produced better oocyte and embryo parameters, the clinical pregnancy rate and the implantation rates were comparable between the flexible-multidose GnRH antagonist and MF protocols in poor responder patients.

  15. Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study.

    Science.gov (United States)

    Shimada, Yuichi J; Tsugawa, Yusuke; Iso, Hiroyasu; Brown, David F M; Hasegawa, Kohei

    2017-08-23

    Hypertension carries a large societal burden. Obesity is known as a risk factor for hypertension. However, little is known as to whether weight loss interventions reduce the risk of hypertension-related adverse events, such as acute care use (emergency department [ED] visit and/or unplanned hospitalization). We used bariatric surgery as an instrument for investigating the effect of large weight reduction on the risk of acute care use for hypertension-related disease in obese adults with hypertension. We performed a self-controlled case series study of obese patients with hypertension who underwent bariatric surgery using population-based ED and inpatient databases that recorded every bariatric surgery, ED visit, and hospitalization in three states (California, Florida, and Nebraska) from 2005 to 2011. The primary outcome was acute care use for hypertension-related disease. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. We identified 980 obese patients with hypertension who underwent bariatric surgery. The median age was 48 years (interquartile range, 40-56 years), 74% were female, and 55% were non-Hispanic white. During the reference period, 17.8% (95% confidence interval [CI], 15.4-20.2%) had a primary outcome event. The risk remained unchanged in the subsequent 12-month pre-surgery period (18.2% [95% CI, 15.7-20.6%]; adjusted odds ratio [aOR] 1.02 [95% CI, 0.83-1.27]; P = 0.83). In the first 12-month period after bariatric surgery, the risk significantly decreased (10.5% [8.6-12.4%]; aOR 0.58 [95% CI, 0.45-0.74]; P bariatric surgery (12.9% [95% CI, 10.8-15.0%]; aOR 0.71 [95% CI, 0.57-0.90]; P = 0.005). By contrast, there was no significant reduction in the risk among obese patients who underwent non-bariatric surgery (i.e., cholecystectomy, hysterectomy, spinal fusion, or mastectomy). In this population-based study of

  16. The Plastic Surgery Hand Curriculum.

    Science.gov (United States)

    Silvestre, Jason; Levin, L Scott; Serletti, Joseph M; Chang, Benjamin

    2015-12-01

    Designing an effective hand rotation for plastic surgery residents is difficult. The authors address this limitation by elucidating the critical components of the hand curriculum during plastic surgery residency. Hand questions on the Plastic Surgery In-Service Training Exam for six consecutive years (2008 to 2013) were characterized by presence of imaging, vignette setting, question taxonomy, answer domain, anatomy, and topic. Answer references were quantified by source and year of publication. Two hundred sixty-six questions were related to hand surgery (22.7 percent of all questions; 44.3 per year) and 61 were accompanied by an image (22.9 percent). Vignettes tended to be clinic- (50.0 percent) and emergency room-based (35.3 percent) (p < 0.001). Questions required decision-making (60.5 percent) over interpretation (25.9 percent) and recall skills (13.5 percent) (p < 0.001). Answers focused on interventions (57.5 percent) over anatomy/pathology (25.2 percent) and diagnoses (17.3 percent) (p < 0.001). Nearly half of the questions focused on the digits. The highest yield topics were trauma (35.3 percent), reconstruction (24.4 percent), and aesthetic and functional problems (14.2 percent). The Journal of Hand Surgery (American volume) (20.5 percent) and Plastic and Reconstructive Surgery (18.0 percent) were the most-cited journals, and the median publication lag was 7 years. Green's Operative Hand Surgery was the most-referenced textbook (41.8 percent). These results will enable trainees to study hand surgery topics with greater efficiency. Faculty can use these results to ensure that tested topics are covered during residency training. Thus, a benchmark is established to improve didactic, clinical, and operative experiences in hand surgery.

  17. Gait and electromyographic analysis of patients recovering after limb-saving surgery

    NARCIS (Netherlands)

    De Visser, E; Mulder, T; Schreuder, HWB; Veth, RPH; Duysens, J

    2000-01-01

    Objective. Control of gait after limb-saving surgery. Design. Case series study. Background. At the moment little is known about adaptations in patients' gait after limb-saving surgery. Methods. Nineteen patients who underwent limb-saving surgery at least 1 yr earlier and 10 normal subjects were

  18. Association of Bariatric Surgery With Risk of Infectious Diseases: A Self-Controlled Case Series Analysis.

    Science.gov (United States)

    Goto, Tadahiro; Hirayama, Atsushi; Faridi, Mohammad Kamal; Camargo, Carlos A; Hasegawa, Kohei

    2017-10-15

    Although emerging data demonstrate that obesity is a risk factor for infectious diseases, no study has investigated the relationship of bariatric surgery with the risk of infectious diseases among obese adults. We conducted a self-controlled case series analysis using data from the State Emergency Department Database and State Inpatient Database of 3 US states (California, Florida, and Nebraska) from 2005 through 2011. We included obese adults who underwent bariatric surgery as an instrument of weight reduction. Primary outcomes were emergency department (ED) visit or hospitalization for skin and soft-tissue infection (SSTI), respiratory infection, intra-abdominal infection, or urinary tract infection (UTI). Among 56277 obese adults who underwent bariatric surgery, compared to presurgery months 13-24 as the reference period, the risk of ED visit or hospitalization in the 0- to 12-month postsurgery period decreased significantly for SSTI (aOR, 0.85 [95% confidence interval {CI}, .76-.95]) and respiratory infection (aOR, 0.82 [95% CI, .75-.90]) and remained significantly low in the 13- to 24-month postsurgery period (aORs, 0.77 [95% CI, .68-.86] and 0.75 [95% CI, .68-.82], respectively). By contrast, the risk increased significantly in the 0- to 12-month postsurgery period for intra-abdominal infection (aOR, 2.09 [95% CI, 1.78-2.46]) and UTI (aOR, 1.93 [95% CI, 1.74-2.15]) and remained high in the 13- to 24-month postsurgery period (aORs, 1.29 [95% CI, 1.09-1.54] and 1.31 [95% CI, 1.17-1.47], respectively). We found a divergent risk pattern in the risk of 4 common infectious diseases after bariatric surgery. The risk of SSTI and respiratory infection decreased after bariatric surgery whereas that of intra-abdominal infection and UTI increased. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  19. Prophylactic Appendectomy during Laparoscopic Surgery for Other Conditions

    Directory of Open Access Journals (Sweden)

    S. Occhionorelli

    2014-01-01

    Full Text Available Acute appendicitis remains the most common surgical emergency. Laparoscopy has gained increasing favor as a method of both investigating right iliac fossa pain and treating the finding of appendicitis. A question arises: what to do with an apparent healthy appendix discovered during laparoscopic surgery for other pathology. We present a case of unilateral hydroureteronephrosis complicated with rupture of the renal pelvis, due to gangrenous appendicitis with abscess of the right iliopsoas muscle and periappendicular inflammation in a 67-year-old woman, who underwent laparoscopic right annessiectomy for right ovarian cyst few years earlier, in which a healthy appendix was left inside. There is a lack of consensus in the literature about what to do with a normal appendix. The main argument for removing an apparently normal appendix is that endoluminal appendicitis may not be recognized during surgery, leading to concern that an abnormal appendix is left in place. Because of a lack of evidence from randomized trials, it remains unclear whether the benefits of routine elective coincidental appendectomy outweigh the costs and risks of morbidity associated with this prophylactic procedure. Nevertheless, it appears, from limited data, that women aged 35 years and under benefit most from elective coincidental appendectomy.

  20. Technical consideration of transforaminal endoscopic spine surgery for central herniation

    Directory of Open Access Journals (Sweden)

    Girish P Datar

    2017-01-01

    Full Text Available Introduction: Lumbar disc prolapse is most common between 30 and 50 years of age and is associated with severe disability and pain. It commonly occurs at L4/5 and L5/S1. Transforaminal endoscopic discectomy is an emerging technique for treatment of degenerative disc disease. Literature has shown clinical outcomes, comparable to classical open and micro lumbar discectomy. Central disc herniations in lumbar spine pose technical challenge for transforaminal endoscopic decompression due to its location. Existing techniques to access central herniations and ventral epidural space have trajectory related challenges due to the proximity of the retroperitoneal space and abdominal organs and technically difficult for the less experienced surgeon. Materials and Methods: Thirty patients – 19 males and 11 females – with central, multifocal, central-paracentral disc herniations in the lumbar spine operated in 2015 and 2016 were considered in this study. All patients underwent selective endoscopic discectomy under monitored care anesthesia and local anesthesia with modification of the classical technique, medialization of annulotomy, undercutting the nonarticular part of superior articular process (foraminotomy and use of articulating and long jaw instruments either alone or in combination. Results: In all the thirty patients, we were able to achieve adequate decompression with neurological recovery. All patients improved in their neurological status. Postoperatively, visual analog scale dropped from 7.8 to 1.8 and ODI dropped from 73.46% to 32. 90% of the patients reported excellent and good results. One patient had recurrent herniation and was treated with transforaminal surgery. One patient had persistent back pain and reported poor outcome. Three patients underwent medial branch block for facet joint pain followed by medial branch rhizotomy and reported excellent and good results. Conclusion: Transforaminal endoscopic spine surgery with modifications

  1. The economics of pancreas surgery.

    Science.gov (United States)

    Vollmer, Charles M

    2013-06-01

    Pancreas surgery is a paradigm for high-acuity surgical specialization. Given the current intrigue over containing health care expenditures, pancreas surgery provides an ideal model to investigate the cost of care. This article explores the economics of this field from literature accrued over the last 2 decades. The cost of performing a pancreatic resection is established and then embellished with a discussion of the effects of clinical care paths. Then the influence of complications on costs is explored. Next, cost is investigated as an emerging outcome metric regarding variations in pancreatic surgical care. Finally, the societal-level fiscal impact is considered. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Long-term results after proximal thoracic aortic redo surgery.

    Directory of Open Access Journals (Sweden)

    Martin Czerny

    Full Text Available OBJECTIVE: To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery. METHODS: We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40 who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed. RESULTS: In hospital mortality was 13%, perioperative neurologic injury was 7%. Fifty percent of patients underwent redo surgery in an urgent or emergency setting. In 65%, partial or total arch replacement with or without conventional or frozen elephant trunk extension was performed. The preoperative logistic EuroSCORE I confirmed to be a reliable predictor of adverse outcome- (ROC 0.786, 95%CI 0.64-0.93 as did the new EuroSCORE II model: ROC 0.882 95%CI 0.78-0.98. Extensive individual logistic EuroSCORE I levels more than 67 showed an OR of 7.01, 95%CI 1.43-34.27. A EuroSCORE II larger than 28 showed an OR of 4.44 (95%CI 1.4-14.06. Multivariate logistic regression analysis identified a critical preoperative state (OR 7.96, 95%CI 1.51-38.79 but not advanced age (OR 2.46, 95%CI 0.48-12.66 as the strongest independent predictor of in-hospital mortality. Median follow-up was 23 months (1-52 months. One year and five year actuarial survival rates were 83% and 69% respectively. Freedom from reoperation during follow-up was 100%. CONCLUSIONS: Despite a substantial early attrition rate in patients presenting with a critical preoperative state, proximal thoracic aortic redo surgery provides excellent early and mid-term results. Higher EuroSCORE I and II levels and a critical preoperative state but not advanced age are independent predictors of in-hospital mortality. As a consequence, age alone should no longer be regarded as a contraindication for surgical treatment in this particular group of patients.

  3. Frequency and Predictors of Cognitive Decline in Patients Undergoing Coronary Artery Bypass Graft Surgery

    International Nuclear Information System (INIS)

    Habib, S.; Khan, A. R.; Afridi, M. I.; Saeed, A.; Jan, A. F.; Amjad, N.

    2014-01-01

    Objective: To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS). Study Design: An observational study. Place and Duration of Study: The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009. Methodology: Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. Results: One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 +- 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. Conclusion: Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time. (author)

  4. Comparison of outcomes following laparoscopic and open treatment of emergent small bowel obstruction: an 11-year analysis of ACS NSQIP.

    Science.gov (United States)

    Patel, Richa; Borad, Neil P; Merchant, Aziz M

    2018-06-04

    Small bowel obstruction (SBO) continues to be a common indication for acute care surgery. While open procedures are still widely used for treatment, laparoscopic procedures may have important advantages in certain patient populations. We aim to analyze differences in outcomes between the two for treatment of bowel obstruction. The American College of Surgeons National Surgical Quality Improvement Program was used to find patients that underwent emergent or non-elective surgery for SBO. Propensity matching was used to create comparable groups. Logistic regression was used to assess differences in the primary outcome of interest, return to operating room, and morbidity and mortality outcomes. Logistic regression was also used to assess the contribution of various preoperative demographic and comorbidity characteristics to 30-day mortality. A total of 24,028 patients underwent surgery for SBO from 2005 to 2011. Of those, 3391 were laparoscopic. Propensity matching resulted in 6782 matched patients. Laparoscopic cases had significantly decreased odds of experiencing any morbidity and wound complications compared to open cases in bowel-resection and adhesiolysis-only cases. There was no significant difference found for odds of returning to operating room. Laparoscopic cases resulted in significantly shorter hospital stays than open cases (7.18 vs.10.84 days, p  25) decreased odds of mortality. Analysis of emergent SBO cases between 2005 and 2015 demonstrates that laparoscopy is not utilized as often as open approaches in surgical treatment. Laparoscopic surgery resulted in reduced postoperative morbidity and significantly shorter hospital stays compared to open intervention and was not associated with significant differences in odds of reoperation compared to open surgery.

  5. Pulmonary complications after abdominal surgery in patients with mild-to-moderate chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Kim TH

    2016-11-01

    Full Text Available Tae Hoon Kim, Jae Seung Lee, Sei Won Lee, Yeon-Mok Oh Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Abstract: Postoperative pulmonary complications (PPCs are one of the most important causes of postoperative morbidity and mortality after abdominal surgery. Although chronic obstructive pulmonary disease (COPD has been considered a risk factor for PPCs, it remains unclear whether mild-to-moderate COPD is a risk factor. This retrospective cohort study included 387 subjects who underwent abdominal surgery with general anesthesia in a tertiary referral hospital. PPCs included pneumonia, pulmonary edema, pulmonary thromboembolism, atelectasis, and acute exacerbation of COPD. Among the 387 subjects, PPCs developed in 14 (12.0% of 117 patients with mild-to-moderate COPD and in 13 (15.1% of 86 control patients. Multiple logistic regression analysis revealed that mild-to-moderate COPD was not a significant risk factor for PPCs (odds ratio [OR] =0.79; 95% confidence interval [CI] =0.31–2.03; P=0.628. However, previous hospitalization for respiratory problems (OR =4.20; 95% CI =1.52–11.59, emergency surgery (OR =3.93; 95% CI =1.75–8.82, increased amount of red blood cell (RBC transfusion (OR =1.09; 95% CI =1.05–1.14 for one pack increase of RBC transfusion, and laparoscopic surgery (OR =0.41; 95% CI =0.18–0.93 were independent predictors of PPCs. These findings suggested that mild-to-moderate COPD may not be a significant risk factor for PPCs after abdominal surgery.Keywords: postoperative pulmonary complications, spirometry, risk factor, abdominal surgery, postoperative complications, postoperative care

  6. Obesity is associated with increased health care charges in patients undergoing outpatient plastic surgery.

    Science.gov (United States)

    Sieffert, Michelle R; Fox, Justin P; Abbott, Lindsay E; Johnson, R Michael

    2015-05-01

    Obesity is associated with greater rates of surgical complications. To address these complications after outpatient plastic surgery, obese patients may seek care in the emergency department and potentially require admission to the hospital, which could result in greater health care charges. The purpose of this study was to determine the relationship of obesity, postdischarge hospital-based acute care, and hospital charges within 30 days of outpatient plastic surgery. From state ambulatory surgery center databases in four states, all discharges for adult patients who underwent liposuction, abdominoplasty, breast reduction, and blepharoplasty were identified. Patients were grouped by the presence or absence of obesity. Multivariable regression models were used to compare the frequency of hospital-based acute care, serious adverse events, and hospital charges within 30 days between groups while controlling for confounding variables. The final sample included 47,741 discharges, with 2052 of these discharges (4.3 percent) being obese. Obese patients more frequently had a hospital-based acute care encounter [7.3 percent versus 3.9 percent; adjusted OR, 1.35 (95% CI,1.13 to 1.61)] or serious adverse event [3.2 percent versus 0.9 percent; adjusted OR, 1.73 (95% CI, 1.30 to 2.29)] within 30 days of surgery. Obese patients had adjusted hospital charges that were, on average, $3917, $7412, and $7059 greater (p Obese patients who undergo common outpatient plastic surgery procedures incur substantially greater health care charges, in part attributable to more frequent adverse events and hospital-based health care within 30 days of surgery. Risk, II.

  7. Wernicke's encephalopathy after cardiac surgery.

    Science.gov (United States)

    Nishimura, Yoshiyuki

    2018-05-01

    A 76-year-old woman who had been on hemodialysis for 3 years developed ischemic mitral valve insufficiency, tricuspid insufficiency, and chronic atrial fibrillation, and underwent cardiac surgery. On the 4th postoperative day, she experienced a sudden disturbance of consciousness, aphasia, and limb ataxia. Brain computed tomography and magnetic resonance imaging showed no abnormalities. Wernicke's encephalopathy was suspected and the patient was given vitamin B1, whereupon her symptoms gradually improved. On the 42nd postoperative day, she was free of neurological symptoms and discharged.

  8. GENERAL SURGERY

    African Journals Online (AJOL)

    2017-11-04

    Nov 4, 2017 ... One of the principles integrated into the South African state healthcare system is the ... care. Similarly, the types and severity of surgical conditions which should be ... Emergency admissions constituted 62.4% and elective admissions ... development of information technology (IT) has allowed the creation of ...

  9. Guidelines for emergency laparoscopy

    Directory of Open Access Journals (Sweden)

    Sauerland Stefan

    2006-10-01

    Full Text Available Abstract Acute abdominal pain is a leading symptom in many surgical emergency patients. Laparoscopy allows for accurate diagnosis and immediate therapy of many intraabdominal pathologies. The guidelines of the EAES (European Association for Endoscopic Surgery provides scientifically founded recommendations about the role of laparoscopy in the different situations. Generally, laparoscopy is well suited for the therapy of the majority of diseases that cause acute abdominal pain.

  10. Clinical Outcomes of patients with coronary artery disease who underwent FFR evaluation of intermediate coronary lesionS– COFFRS study

    Directory of Open Access Journals (Sweden)

    Srinivasa Prasad

    2017-07-01

    Conclusion: In our experience, MACE events were not higher in patients with FFR > 0.8 and kept under medical therapy and were similarly lower in patients with FFR ≤0.8 and underwent revascularisation (p = 0.73. Also MACE events were higher in patients with FFR ≤ 0.8 and did not undergo revascularisation compared to other two appropriately treated groups (p = 0.03. FFR based revascularization decision appears to be a safe strategy in Indian patients.

  11. Remote cerebellar hemorrhage after lumbar spinal surgery

    International Nuclear Information System (INIS)

    Cevik, Belma; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet

    2009-01-01

    Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

  12. Entrepreneurship, Emerging Technologies, Emerging Markets

    NARCIS (Netherlands)

    Thukral, Inderpreet S.; Von Ehr, James; Walsh, Steven Thomas; Groen, Arend J.; van der Sijde, Peter; Adham, Khairul Akmaliah

    2008-01-01

    Academics and practitioners alike have long understood the benefits, if not the risks, of both emerging markets and emerging technologies.Yet it is only recently that foresighted firms have embraced emerging technologies and emerging markets through entrepreneurial activity. Emerging technologies

  13. Patient satisfaction with cataract surgery

    Directory of Open Access Journals (Sweden)

    Wasfi Ehab I

    2008-10-01

    Full Text Available Abstract Introduction Measuring the patient satisfaction is a very important issue that will help very much in improving the service provided to patients and improve the level of satisfaction. Aim To evaluate patient satisfaction with the cataract surgery service and identify any areas for improvement, determination of patient satisfaction with referral, out-patient consultation, pre-assessment clinic, surgery and post-operative care, also to report patients' comments relating to improvement in service provision. Methodology A retrospective study was undertaken for 150 patients underwent cataract surgery at Barrow General Hospital, UK, the survey sample was by postal questionnaires. We collected our data from the theatre lists for a period of 4 month. Results This study included 150 patients; the response rate was (72% 108 patients, Most patients were referred from their general practitioner 86.1%, 93 (86.1% patients were happy with the time interval from seeing their GP to eye clinic. In the eye out patient department many factors significantly affected the level of patient satisfaction, in general the more information provided for the patient the more the satisfaction. Conclusion Patient satisfaction is on important health outcome old understanding both the domains of satisfaction as well as their relative importance to patients is necessary to improve the overall quality of patient care. Meeting the doctor, presenting all relevant information and giving printed information are very important factors in improving the patient's satisfaction with cataract surgery.

  14. Diathermy vs. scalpel skin incisions in general surgery: double-blind, randomized, clinical trial.

    Science.gov (United States)

    Shamim, Muhammad

    2009-08-01

    This prospective, double-blind, randomized, controlled trial was designed to compare the outcome of diathermy incisions versus scalpel incisions in general surgery. A total of 369 patients who underwent diathermy incision (group A: 185 patients) or scalpel incision (group B: 184 patients) were analyzed. Variables analyzed were: surgical wound classification, length and depth of incision, incision time, duration of operation, incisional blood loss, postoperative pain, duration of hospital stay, duration of healing, and postoperative complications. The inclusion criteria were all patients who underwent elective or emergency general surgery. The exclusion criteria were only cases with incomplete patients' data and patients who were lost to follow-up. This study was conducted at Fatima Hospital-Baqai Medical University and Shamsi Hospital (Karachi), from January 2006 to December 2007. Incision time was significantly longer for patients in group B (p = 0.001). Incisional blood loss also was more for patients in group B (p = 0.000). Pain perception was found to be markedly reduced during the first 48 h in group A (p = 0.000). Total period of hospital stay (p = 0.129) and time for complete wound healing (p = 0.683) were almost the same for both groups. Postoperative complication rate by wound classification did not differ markedly between the two groups (p = 0.002 vs. p = 0.000). Diathermy incision has significant advantages compared with the scalpel because of reduced incision time, less blood loss, & reduced early postoperative pain.

  15. [Sixteen Cases of Colon Stenting as a Bridge to Surgery(BTS)for Obstructive Colorectal Cancer].

    Science.gov (United States)

    Otsuka, Ryo; Saito, Shuji; Hirayama, Ryouichi; Miura, Yasuaki; Sasaki, Kazunori; Miyajima, Ayako; Kuwamoto, Nobutsuna; Kataoka, Ryoko; Shindo, Yukito; Fujita, Rikiya

    2017-11-01

    Colonic stent insertion is widely used as a bridge to surgery(BTS)for obstructive colorectal cancer. Stenting can shorten hospitalization and decrease complication and colostomy rates in comparison with emergency surgery. We investigated patients who underwent colonic stent insertion for BTS in our hospital. Sixteen patients(8 men, 8 women) with a colorectal obstruction score of 0 or 1 who underwent colonic stent insertion as a BTS between April 2015 and April 2017 period were investigated. Mean patient age was 68.2(45-94)years. Technical success was obtained in all patients, and clinical success in 14(87%). Total colonoscopy was possible via stent in 10 patients. Nine patients were temporarily discharged from the hospital, and median time to operation was 18(2-43)days. Laparoscopic resection was performed in 14 patients, and anastomotic leakage was a postoperative complication in 1 patient. Colostomy was performed in only 1 patient with anastomotic leakage. Good results were obtained with careful patient selection and safe colonic stent insertion.

  16. Hypoglossal Nerve Palsy After Cervical Spine Surgery.

    Science.gov (United States)

    Ames, Christopher P; Clark, Aaron J; Kanter, Adam S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Multi-institutional retrospective study. The goal of the current study is to quantify the incidence of 2 extremely rare complications of cervical spine surgery; hypoglossal and glossopharyngeal nerve palsies. A total of 8887 patients who underwent cervical spine surgery from 2005 to 2011 were included in the study from 21 institutions. No glossopharyngeal nerve injuries were reported. One hypoglossal nerve injury was reported after a C3-7 laminectomy (0.01%). This deficit resolved with conservative management. The rate by institution ranged from 0% to 1.28%. Although not directly injured by the surgical procedure, the transient nerve injury might have been related to patient positioning as has been described previously in the literature. Hypoglossal nerve injury during cervical spine surgery is an extremely rare complication. Institutional rates may vary. Care should be taken during posterior cervical surgery to avoid hyperflexion of the neck and endotracheal tube malposition.

  17. Vitreoretinal surgery in advanced coats disease.

    Science.gov (United States)

    Ozdamar, Yasemin; Berker, Nilufer; Batman, Cosar; Zilelioglu, Orhan

    2009-01-01

    To report the outcomes of vitreoretinal surgery for a patient with total retinal detachment and a subretinal nodule associated with Coats disease (CD). A 20-year-old woman stage 3B CD underwent vitreoretinal surgery with triamcinolone acetonide-assisted pars plana vitrectomy, limited retinotomy, removal of the subretinal nodule and membrane, endolaser photocoagulation, and silicone oil tamponade. The surgical outcomes were observed. Retinal attachment was achieved after vitreoretinal surgery, removal of the subretinal membrane, and endoresection of the subretinal fibrous nodule. No intraoperative or postoperative complications occurred due to the surgical technique. The retina remained attached during the postoperative follow-up period of 6 months. Vitreoretinal surgery is an effective surgical technique that provides successful reattachment of the retina and enables endoresection of the subretinal fibrous nodule in eyes with advanced CD. It also prevents the devastating intraocular complications leading to enucleation.

  18. Danish experience with paediatric epilepsy surgery

    DEFF Research Database (Denmark)

    Underbjerg, Ebba von Celsing; Hoei-Hansen, Christina E; Madsen, Flemming Find

    2015-01-01

    INTRODUCTION: Epilepsy surgery is increasingly used to treat children with medically intractable epilepsy. This study investigates the aetiology and seizure outcome in Danish children operated between 1996 and 2010. METHODS: Retrospectively collected data on structural magnetic resonance imaging...... of children who undergo epilepsy surgery have a good, worthwhile seizure outcome. The seizure outcome for Danish children corresponds to that of other epilepsy surgery centres. The clinical criteria for selection of patients changed over time. FUNDING: none. TRIAL REGISTRATION: The Danish Data Protection...... (MRI) diagnoses, surgical procedures and seizure outcomes classified according to the Engel Classification were used. Changes over time grouped as 1996-2000, 2001-2005 and 2006-2010 were analysed. RESULTS: A total of 95 children underwent epilepsy surgery. Sixty-three operations were performed...

  19. Danish experience with paediatric epilepsy surgery

    DEFF Research Database (Denmark)

    Underbjerg, Ebba von Celsing; Hoei-Hansen, Christina E; Madsen, Flemming Find

    2015-01-01

    INTRODUCTION: Epilepsy surgery is increasingly used to treat children with medically intractable epilepsy. This study investigates the aetiology and seizure outcome in Danish children operated between 1996 and 2010. METHODS: Retrospectively collected data on structural magnetic resonance imaging...... (MRI) diagnoses, surgical procedures and seizure outcomes classified according to the Engel Classification were used. Changes over time grouped as 1996-2000, 2001-2005 and 2006-2010 were analysed. RESULTS: A total of 95 children underwent epilepsy surgery. Sixty-three operations were performed...... of children who undergo epilepsy surgery have a good, worthwhile seizure outcome. The seizure outcome for Danish children corresponds to that of other epilepsy surgery centres. The clinical criteria for selection of patients changed over time. FUNDING: none. TRIAL REGISTRATION: The Danish Data Protection...

  20. Diode laser surgery. Ab interno and ab externo versus conventional surgery in rabbits.

    Science.gov (United States)

    Karp, C L; Higginbotham, E J; Edward, D P; Musch, D C

    1993-10-01

    Fibroblastic proliferation of subconjunctival tissues remains a primary mechanism of failure in filtration surgery. Minimizing the surgical manipulation of episcleral tissues may reduce scarring. Laser sclerostomy surgery involves minimal tissue dissection, and is gaining attention as a method of potentially improving filter duration in high-risk cases. Twenty-five New Zealand rabbits underwent filtration surgery in one eye, and the fellow eye remained as the unoperated control. Ten rabbits underwent ab externo diode laser sclerostomy surgery, ten underwent ab interno diode sclerostomy surgery, and five had posterior sclerostomy procedures. Filtration failure was defined as a less-than-4-mmHg intraocular pressure (IOP) difference between the operative and control eyes. The mean time to failure for the ab externo, ab interno, and conventional posterior sclerostomy techniques measured 17.4 +/- 11.5, 13.1 +/- 6.7, and 6.0 +/- 3.1 days, respectively. In a comparison of the laser-treated groups with the conventional procedure, the time to failure was significantly longer (P = 0.02) for the ab externo filter. The mean ab interno sclerostomy duration was longer than the posterior lip procedure, but this difference was not statistically significant (P = 0.15). The overall level of IOP reduction was similar in the three groups. These data suggest that diode laser sclerostomy is a feasible technique in rabbits, and the ab externo approach resulted in longer filter duration than the conventional posterior lip procedure in this model.

  1. No more broken hearts: weight loss after bariatric surgery returns patients' postoperative risk to baseline following coronary surgery.

    Science.gov (United States)

    Baimas-George, Maria; Hennings, Dietric L; Al-Qurayshi, Zaid; Emad Kandil; DuCoin, Christopher

    2017-06-01

    The obesity epidemic is associated with a rise in coronary surgeries because obesity is a risk factor for coronary artery disease. Bariatric surgery is linked to improvement in cardiovascular co-morbidities and left ventricular function. No studies have investigated survival advantage in postoperative bariatric patients after coronary surgery. To determine if there is a benefit after coronary surgery in patients who have previously undergone bariatric surgery. National Inpatient Sample. We performed a retrospective, cross-sectional analysis of the National Inpatient Sample database from 2003 to 2010. We selected bariatric surgical patients who later underwent coronary surgery (n = 257). A comparison of postoperative complications and mortality after coronary surgery were compared with controls (n = 1442) using χ 2 tests, linear regression analysis, and multivariate logistical regression models. A subset population was identified as having undergone coronary surgery (n = 1699); of this population, 257 patients had previously undergone bariatric surgery. They were compared with 1442 controls. The majority was male (67.2%), white (82.6%), and treated in an urban environment (96.8%). Patients with bariatric surgery assumed the risk of postoperative complications after coronary surgery that was associated with their new body mass index (BMI) (BMI999.9, 95% CI .18 to>999.9, P = .07). Length of stay was significantly longer in postbariatric patients (BMIbariatric patients have a return to baseline risk of morbidity and mortality after coronary surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. Documentation of Pregnancy Status, Gynaecological History, Date of Last Menstrual Period and Contraception Use in Emergency Surgical Admissions: Time for a Change in Practice?

    Science.gov (United States)

    Powell-Bowns, M; Wilson, M S J; Mustafa, A

    2015-12-01

    To determine whether pregnancy status, gynaecological history, date of last menstrual period and contraceptive use are documented in emergency female admissions of reproductive age admitted to general surgery. This is a retrospective study. This study was conducted in the United Kingdom. Females of reproductive age (12-50 years) admitted as an emergency to general surgery with abdominal pain were considered in this study. Retrospective analysis of medical notes of emergency female admissions with abdominal pain between January and September 2012. We recorded whether a pregnancy test result was documented (cycle 1). Results were analysed and a prompt added to the medical clerk-in document. We re-audited (cycle 2) between January and June 2013 looking for improvement. Documented pregnancy status within 24 h of admission and prior to any surgical intervention. 100 case notes were reviewed in stage 1. 30 patients (30 %) had a documented pregnancy status. 32 (32 %), 25 (25 %) and 29 (29 %) had a documented gynaecology history, contraceptive use and date of last menstrual period (LMP), respectively. 24 patients underwent emergency surgery, 6 (25 %) had a documented pregnancy status prior to surgery. Of 50 patients reviewed in stage 2, 37 (75.0 %) had a documented pregnancy status (p contraceptive use (p < 0.0001) documented. 40 patients (80 % had a documented LMP (p < 0.0001). 7 patients required surgery, of whom 6 (85.7 %) had a documented pregnancy test prior to surgery (p = 0.001). All pregnancy tests were negative. A simple prompt in the surgical admission document has significantly improved the documentation of pregnancy status and gynaecological history in our female patients, particularly in those who require surgical intervention. A number of patient safety concerns were addressed locally, but require a coordinated, interdisciplinary discussion and a national guideline. A minimum standard of care, in females of reproductive age, should include mandatory objective

  3. Improvement of gastroesophageal reflux disease in Japanese patients with spinal kyphotic deformity who underwent surgical spinal correction.

    Science.gov (United States)

    Sugimoto, Mitsushige; Hasegawa, Tomohiko; Nishino, Masafumi; Sahara, Shu; Uotani, Takahiro; Ichikawa, Hitomi; Kagami, Takuma; Sugimoto, Ken; Yamato, Yu; Togawa, Daisuke; Kobayashi, Sho; Hoshino, Hironobu; Matsuyama, Yukihiro; Furuta, Takahisa

    2016-01-01

    Spinal kyphotic deformity occasionally results in gastroesophageal reflux disease (GERD). The effects of acid reflux on the esophagus in kyphotic patients are unclear, however, and it is unknown whether acid reflux, endoscopic GERD, and reflux-related symptoms improve following surgical spinal correction in these patients. Herein, we investigated the characteristics of GERD in kyphotic patients and the improvement in GERD following surgical correction. In 48 patients with severe kyphotic deformity scheduled for surgical spinal correction, we conducted esophagogastroduodenoscopy, 24-h pH monitoring and three questionnaire surveys, including the frequency scale for the symptoms of GERD (FSSG). We repeated these measurements after surgical correction and compared pre- and post-surgery values. Of 48 patients, 70.8% [95% CI: 55.9-83.0%, 34/48] had endoscopically evaluated esophageal mucosal injury. Regarding pH before surgery, 64.9% (CI: 47.5-79.8%, 24/37) had abnormal acid reflux (intraesophageal pH reflux decreased from 66.7% (95% CI: 41.0-86.7%) to 33.3% (95% CI: 13.3-59.0%) (P = 0.045). Surgical spinal correction in kyphosis patients improves not only kyphotic deformity-related disorders but also esophageal mucosal injury, abnormal acid reflux, and reflux-related symptoms. © 2015 Japan Gastroenterological Endoscopy Society.

  4. Transsphenoidal surgery for pituitary tumors from microsurgery to the endoscopic surgery. Single surgeon's experience

    International Nuclear Information System (INIS)

    Iwai, Yoshiyasu; Yoshimura, Masaki; Terada, Aiko; Yamanaka, Kazuhiro; Koshimo, Naomi

    2011-01-01

    We reviewed results of the surgical outcome of pituitary tumors treated via the transsphenoidal approach between January, 1994 and January, 2010 at our institution. This data included 100 patients (124 procedures) treated through the sublabial transsphenoidal approach and 45 patients (54 procedures) treated through the endoscopic endonasal (bilateral nostrils) transsphenoidal approach performed by a single surgeon. The extent of tumor removal was significantly improved with endoscopic surgery; adjuvant gamma knife radiosurgery was needed for 65% of patients undergoing microsurgery vs. 30% for patients who had endoscopic surgery (p<0.0001). Patients who underwent endoscopic surgery had less intraoperative blood loss (mean volume: 100 mL for microsurgery patients vs. 30 mL for endoscopic surgery patients, p<0.0001), less pain, and less need for postoperative hormone replacement therapy (19% for microsurgery patients vs. 6% for endoscopic surgery patients; p<0.05). Cerebrospinal fluid (CSF) leakage and meningitis were experienced in one microsurgery patient (1%) and one endoscopic surgery patient (2.2%). Endoscopic surgery is a reasonable alternative to microsurgery and our experience supports the concept that an otolaryngologist/neurosurgeon team skilled in endoscopic techniques and pituitary surgery can safely make the transition from microsurgery to endoscopic surgery. (author)

  5. Radical surgery compared with intracavitary cesium followed by radical surgery in cervical carcinoma stage IB

    Energy Technology Data Exchange (ETDEWEB)

    Tinga, D.J.; Bouma, J.; Aalders, J.G. (Dept. of Obstetrics and Gynaecology, State Univ. Hospital, Groningen (Netherlands)); Hollema, H. (Dept. of Pathology, State Univ. Hospital, Groningen (Netherlands))

    1990-01-01

    Forty-nine patients aged {le} 45 years, with cervical carcinoma stage IB ({le} 3 cm) were treated with either primary radical surgery (n = 26), or intracavitary irradiation followed by radical surgery (n = 23). With primary surgery, ovarian function had been preserved in 15 of the 25 patients, who were alive and well. Seven of the primary surgery patients were irradiated postoperatively and 2 others with a central recurrence were cured by irradiation. One other patient, who was not irradiated postoperatively, had an intestinal metastasis and died of the disease. If any of the adverse prognostic factors (as reported in the literature) had been considered as an indication for postoperative irradiation, 17 patients instead of 7 would have been irradiated after primary radical surgery. In the comparable group of 23 patients treated by intracavitary irradiation and radical surgery (and in 4 cases postoperative irradiation as well) there was no recurrence. There was no significant statistical difference between the treatment results in the cesium + surgery group and those who underwent primary radical surgery. Young patients with early cervical carcinoma without prognostic indicators for postoperative irradiation can benefit from primary radical surgery, because their ovarian function can be preserved. (authors).

  6. Radical surgery compared with intracavitary cesium followed by radical surgery in cervical carcinoma stage IB

    International Nuclear Information System (INIS)

    Tinga, D.J.; Bouma, J.; Aalders, J.G.; Hollema, H.

    1990-01-01

    Forty-nine patients aged ≤ 45 years, with cervical carcinoma stage IB (≤ 3 cm) were treated with either primary radical surgery (n = 26), or intracavitary irradiation followed by radical surgery (n = 23). With primary surgery, ovarian function had been preserved in 15 of the 25 patients, who were alive and well. Seven of the primary surgery patients were irradiated postoperatively and 2 others with a central recurrence were cured by irradiation. One other patient, who was not irradiated postoperatively, had an intestinal metastasis and died of the disease. If any of the adverse prognostic factors (as reported in the literature) had been considered as an indication for postoperative irradiation, 17 patients instead of 7 would have been irradiated after primary radical surgery. In the comparable group of 23 patients treated by intracavitary irradiation and radical surgery (and in 4 cases postoperative irradiation as well) there was no recurrence. There was no significant statistical difference between the treatment results in the cesium + surgery group and those who underwent primary radical surgery. Young patients with early cervical carcinoma without prognostic indicators for postoperative irradiation can benefit from primary radical surgery, because their ovarian function can be preserved. (authors)

  7. [Cardiac surgery in octogenarian patients: evaluation of predictive factors of mortality, long-term outcome and quality of life].

    Science.gov (United States)

    Viana-Tejedor, Ana; Domínguez, Francisco J; Moreno Yangüela, Mar; Moreno, Raúl; López de Sá, Esteban; Mesa, José M; López-Sendón, José

    2008-10-04

    Increasing life expectancy in Western countries in the last decades has resulted in a significant gradual increasing number of octogenarians referred for cardiac surgery. There is a need for a critical evaluation of the long-term surgical outcome and quality of life in the elderly. The aim of this study is to identify risk factors of mortality in octogenarians undergoing cardiac surgery and to assess the long term survival and quality of life. Data were reviewed on 150 patients aged over 80 years--mean age (standard deviation): 82.7 (2.5) years--who underwent cardiac surgery at our institution in the last 26 years. We analyzed clinical and epidemiological variables included in the European System for Cardiac Operative Risk Evaluation (euroSCORE), in-hospital morbidity and mortality, long term survival and quality of life after cardiac surgery. The 30-day mortality rate was 30.1%, with a mean hospital stay of 16.5 days (13-27). Emergent procedure, reparation of postinfarction ventricular ruptures, New York Heart Association functional class IV, chronic renal failure and previous myocardial infarction were independent predictors of in-hospital mortality. Mean follow up was 72.2 (9.9) months with survival rates of 87.3% and 57% at 1 and 5 years, respectively. Late postoperative quality of life in our 53 long-term survivors was significantly better than prior to surgery. New York Heart Association functional class improved from 2.52 to 1.48. Most survivors (97.7%) were satisfied with present quality of life Cardiac surgery in octogenarians is associated with increased in-hospital mortality rate and longer hospital stay. Our findings support that cardiac surgery can be performed in a selected elderly population with good long-term survival and quality of life.

  8. Laparoscopic Surgery for the Treatment of Ectopic Pregnancy

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    Hulusi B ZEYNELOGLU

    2005-09-01

    Full Text Available OBJECTIVE: To evaluate the outcomes of laparoscopic surgery for the treatment of ectopic pregnancy Design: 43 women with ectopic pregnancy who underwent laparoscopic surgery in our department between 1996 and 2005 were included in this study.\tSetting: Department of Obstetrics and Gynecology, School of Medicine, Baskent University, Ankara Patients: 43 women with ectopic pregnancy who underwent laparoscopic surgery Interventions: Laparoscopic surgery was performed the treatment of ectopic pregnancy Main Outcome Measures: Patients characteristics such as age, parity, gestational age at the time of diagnosis, symptoms, preoperative and postoperative serum _-hCG and hemoglobin levels, sonographic findings, type of laparoscopic surgery, blood transfusion, additional treatments, endometrial sampling and postoperative fertility status were recorded. The size and the location of myomas were obtained from the surgeon’s findings in the operative note. Preoperative and postoperative hemoglobin values, change in hemoglobin values, hemorrhage, blood transfusion, postoperative fewer, duration of operation and length of postoperative hospital stay were the main outcomes. RESULTS: Forty-three women with ectopic pregnancy who underwent laparoscopic surgery were included in this study. Patients were submitted usually with pelvic pain and abnormal vaginal bleeding. Adnexal mass and hemoperitoneum were seen by sonographic evaluation. Ampuller pregnancy was the most common. Most of patients had conservative surgery and 38% of patients underwent salpingectomy. 12 patient had blood transfusion and two ones underwent re-laparoscopy. After treatment 5 intrauterine pregnancies were occurred. Endometrial samplings usually defined as decidual en Aria stella reactions. Serum _-hCG levels were in normal range at the end of the month after the laparoscopy. CONCLUSION: In conclusion according to these findings, laparoscopic surgery remains the definitive and universal

  9. Evaluation of long-term results and quality of life in patients who underwent rib fixation with titanium devices after trauma.

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    Billè, Andrea; Okiror, Lawrence; Campbell, Aideen; Simons, Jason; Routledge, Tom

    2013-06-01

    To describe the long-term results, quality of life and chronic pain after chest wall fixation for traumatic rib fracture using a quality of life (QOL) score and a numeric pain score. Retrospective analysis of 10 consecutive patients who underwent surgery for rib fractures after trauma and reconstruction between October 2010 and March 2012. Chest rib fractures were fixed with titanium clips and bars or titanium plates and screws through a posterolateral thoracotomy. Pain was assessed with a numeric pain scale 0-10 and quality of life (QOL) with the EORTC questionnaire QLQ-C30. There were 5 males and 5 females. The median age was 58 years (range 21-80). There were no postoperative deaths. The only postoperative complication observed was a contralateral pleural effusion requiring drainage. Median length of stay of the drain and median length of hospital stay were 2 days (range 0-8) and 4 days (range 1-42 days), respectively. The average follow-up period of operatively managed patients was 14 months (range 8-23.5 months). Seven patients scored the pain as 0, one as 1 (mild), one as 4 (moderate) and one as 8 (severe). Only two patients are taking occasionally pain killers. Only one patient presents severe limitation in his life scoring his QOL as poor. Titanium devices (clips and bars; screws and plates) are effective and safe for repair of rib fractures and showed good long-term results in terms of pain and quality of life after the operation.

  10. Surgery, public health, and Pakistan.

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    Zafar, Syed Nabeel; McQueen, K A Kelly

    2011-12-01

    Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.

  11. Surgery for colorectal cancer in the small town of Komotini

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    Simoglou C

    2012-10-01

    Full Text Available Christos Simoglou, Eirini Gymnopoulou, Lambros Simoglou, Marina Gymnopoulou, Konstantinia Nikolaou, Dimitrios GymnopoulosSurgical Clinic, Sιsmanogleio General Hospital, Komotini, GreeceBackground: Here we report our experience in treating colon cancer in the 5 years from 200 to 2011. Our surgical clinic treated 49 patients with colorectal cancer, of whom 28 (57.14% were men of mean age 62 years and 21 (42.86% were women of mean age 66 years.Methods: In 15 cases, the cancer was related to the rectum (30.61% and the remaining 34 cases (69.39% were related to the colon. We found synchronous cancer in two patients. One was found in the blank and the upper right while the second was found in the transverse and sigmoid colon. Six of our patients suffered from coexisting biliary lithiasis and underwent simultaneous cholecystectomy, and simultaneous bile duct exploration for common bile duct lithiasis was performed in one of these patients.Results: Twenty-eight of the patients with colon cancer were treated surgically on an emergency basis. There were two postoperative deaths due to septic shock and multiple organ failure. In total, we noted seven complications, all of which involved patients who had undergone emergency surgery. The length of hospital stay was 8–14 days. Four patients with stage IV disease died 2 years after surgery, and the remainder are still alive.Conclusion: We conclude that colon cancer still occurs after the sixth decade, with a male predominance, and is mainly located in the rectum and sigmoid colon. The high rate of ileus in our region indicates inadequate diagnostic access for the residents of our region. However, mortality remains low.Keywords: anastomosis, colorectal cancer, Hartmann, colectomy, sigmoidectomy

  12. Sigmoid volvulus in an adolescent girl: staged management with emergency colonoscopic reduction and decompression followed by elective sigmoid colectomy

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    Patel, Ramnik V; Njere, Ike; Campbell, Alison; Daniel, Rejoo; Azaz, Amer; Fleet, Mahmud

    2014-01-01

    A case of acute sigmoid volvulus in a 14-year-old adolescent girl presenting with acute low large bowel obstruction with a background of chronic constipation has been presented. Abdominal radiograph and CT scan helped in diagnosis. She underwent emergency colonoscopic detorsion and decompression uneventfully. Lower gastrointestinal contrast study showed very redundant sigmoid colonic loop without any transition zone and she subsequently underwent elective sigmoid colectomy with good outcome. The sigmoid volvulus should be considered in the differential diagnosis of paediatric acute abdomen presenting with marked abdominal distention, absolute constipation and pain but without vomiting. Plain abdominal radiograph and the CT scan are helpful to confirm the diagnosis. Early colonoscopic detorsion and decompression allows direct visualisation of the vascular compromise, assessment of band width of the volvulus and can reduce complications and mortality. Associated Hirschsprung's disease should be suspected if clinical and radiological features are suggestive in which case a rectal biopsy before definitive surgery should be considered. PMID:25143313

  13. Learning curve for laparoendoscopic single-site surgery for an experienced laparoscopic surgeon

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    Pao-Ling Torng; Kuan-Hung Lin; Jing-Shiang Hwang; Hui-Shan Liu; I-Hui Chen; Chi-Ling Chen; Su-Cheng Huang

    2013-01-01

    Objectives: To assess the learning curve and safety of laparoendoscopic single-site (LESS) surgery of gynecological surgeries. Materials and methods: Sixty-three women who underwent LESS surgery by a single experienced laparoscopic surgeon from February 2011 to August 2011 were included. Commercialized single-incision laparoscopic surgery homemade ports were used, along with conventional straight instruments. The learning curve has been defined as the additional surgical time with respect ...

  14. Achalasia: Dilation, Injection or Surgery?

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    Alberto Peracchia

    2000-01-01

    Full Text Available Achalasia results from irreversible alterations of the esophageal myenteric plexus. The target of treatment in this setting is to reduce lower esophageal sphincter resistance to passage of the bolus. Definitive treatment of the disease requires pneumatic dilation or Heller myotomy. Although no controlled studies comparing modern endoscopic and surgical techniques are available, laparoscopic surgery is emerging as the initial intervention of choice.

  15. Delayed Tension Pneumothorax During Surgery

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    Ying-Lun Chen

    2005-10-01

    Full Text Available Tension pneumothorax is a life-threatening emergency that rapidly results in cardiopulmonary arrest. It requires prompt diagnosis and treatment. We present 2 cases from our practice, 1 caused by blunt chest trauma and the other resulting from laparoscopic surgery. Both were successfully treated by insertion of a chest tube. The diagnosis and treatment of intraoperative pneumothorax is discussed together with a review of the literature.

  16. Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

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    Brandt Carlos Teixeira

    1998-01-01

    Full Text Available Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

  17. The association between orthostatic hypotension and cognitive state among adults 65 years and older who underwent a comprehensive geriatric assessment

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    Punchick, Boris; Freud, Tamar; Press, Yan

    2016-01-01

    Abstract The prevalence of cognitive impairment and orthostatic hypotension (OH) increases with age, but the results of studies that assessed possible associations between them are inconsistent. The aim of this study is to assess possible associations between cognitive impairment and OH in patients ≥65 years of age who underwent a comprehensive geriatric assessment. A retrospective analysis was conducted of the computerized medical records of the study population from 2005 to 2013. Data collected included blood pressure measurements that enabled the calculation of OH, results of the mini-mental state examination (MMSE), results of the Montreal cognitive assessment (MoCA) test, and cognitive diagnoses that were determined over the course of the assessment. The rate of OH in the study population of 571 adults was 32.1%. The mean MMSE score was 22.5 ± 5.2 among participants with OH and 21.6 ± 5.8 among those without OH (P = 0.09). The absence of a significant association between OH and MMSE remained after adjusting the MMSE score for age and education level. The mean MoCA score was 16.4 ± 5.0 among participants with OH and 16.4 ± 4.8 among those without (P = 0.33). The prevalence of OH was 39% among participants without cognitive impairment, 28.9% among those with mild cognitive impairment (MCI), and 30.6% among those with dementia (P = 0.13). There was no association between OH and cognitive impairment in adults who underwent a comprehensive geriatric assessment. PMID:27442658

  18. Contralateral prophylactic mastectomy rate and predictive factors among patients with breast cancer who underwent multigene panel testing for hereditary cancer.

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    Elsayegh, Nisreen; Webster, Rachel D; Gutierrez Barrera, Angelica M; Lin, Heather; Kuerer, Henry M; Litton, Jennifer K; Bedrosian, Isabelle; Arun, Banu K

    2018-05-07

    Although multigene panel testing is increasingly common in patients with cancer, the relationship between its use among breast cancer patients with non-BRCA mutations or variants of uncertain significance (VUS) and disease management decisions has not been well described. This study evaluated the rate and predictive factors of CPM patients who underwent multigene panel testing. Three hundred and fourteen patients with breast cancer who underwent multigene panel testing between 2014 and 2017 were included in the analysis. Of the 314 patients, 70 elected CPM. Election of CPM by gene status was as follows: BRCA carriers (42.3%), non-BRCA carriers (30.1%), and VUS (10.6%). CPM election rates did not differ between non-BRCA carriers and BRCA carriers (P = 0.6205). Among non-BRCA carriers, negative hormone receptor status was associated with CPM (P = 0.0115). For those with a VUS, hormone receptor status was not associated with CPM (P = 0.1879). Although the rate of CPM between BRCA carriers and non-BRCA carriers was not significantly different, the predictors of CPM were different in each group. Our analyses shed the light on the increasing use of CPM among patients who are non-BRCA carriers as well those with a VUS. Our study elucidates the differing predictive factors of CPM election among BRCA carriers, non-BRCA carries, and those with a VUS. Our findings reveal the need for providers to be cognizant that non-BRCA genes and VUS drive women to elect CPM despite the lack of data for contralateral breast cancer risk associated with these genes. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  19. Epilepsy surgery in children: outcomes and complications.

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    Kim, Seung-Ki; Wang, Kyu-Chang; Hwang, Yong-Seung; Kim, Ki Joong; Chae, Jong Hee; Kim, In-One; Cho, Byung-Kyu

    2008-04-01

    Ideal epilepsy surgery would eliminate seizures without causing any functional deficits. The aim of the present study was to assess seizure outcomes and complications after epilepsy surgery in children with intractable epilepsy. Data obtained in 134 children (75 boys and 59 girls) age 17 years or younger who underwent epilepsy surgery at Seoul National University Children's Hospital between 1993 and 2005 were retrospectively reviewed. Epilepsy surgery included temporal resection (59 cases), extratemporal resection (56 cases), functional hemispherectomy (7 cases), callosotomy (9 cases), multiple subpial transection (1 case), and disconnection of a hamartoma (2 cases). The mean follow-up duration was 62.3 months (range 12-168 months). The overall seizure-free rate was 69% (93 of 134 cases). The seizure-free rate was significantly higher in children who underwent temporal resection than in those in whom extratemporal resection was performed (88 vs 55%, p surgery is an effective and safe therapeutic modality in childhood. In children with extratemporal epilepsy, more careful interpretation of clinical and investigative data is needed to achieve favorable seizure outcome.

  20. Seroma formation after surgery for breast cancer

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    Ebrahimi Mandana

    2004-12-01

    Full Text Available Abstract Background Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation. Patients and methods A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM or breast preservation (BP was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel, use of pressure garment, and duration of drainage. The multiple logistic regressio